Utilization Management Nurse

Utilization Management Nurse

Job Description

As a Utilization Management Nurse for Post Acute care, you will be responsible for reviewing and documenting prior authorization and concurrent stay requests. You will also manage member case history in compliance with established policies and procedures, applying clinical criteria and member coverage. This role involves interfacing with members, providers, facilities, medical directors, intake staff, case managers, and other internal departments. Your attention to detail and clinical judgment will be crucial in determining the medical necessity of post-acute stays, including skilled nursing facilities, acute inpatient rehabilitation, and long-term acute care hospitals.

Responsibilities

• Review and document prior authorization and concurrent stay requests.
• Manage and evaluate member case history in line with policies and procedures.
• Interface with members, providers, facilities, medical directors, and various internal departments.
• Apply clinical judgment to assess the medical necessity of post-acute stays.

Essential Skills

• Expertise in utilization management and utilization review.
• Experience in acute care and nursing.
• Proficiency in prior authorization processes.
• Active, unrestricted RN license in the state of MN or WI.
• Associate or bachelor’s degree in nursing.
• 3-5+ years of clinical experience.
• Previous utilization management experience required.

Additional Skills & Qualifications

• Demonstrated clinical assessment skills with critical thinking and evidence-based decision-making.
• Self-motivated and able to work independently and collaboratively.
• Detail-oriented with strong organizational skills.
• Technology-savvy with the ability to navigate multiple computer applications.

Work Environment

This position is remote, requiring 40 hours per week. Candidates must have a primary home address in Wisconsin or Minnesota. Internet speed tests are required, with minimum upload speeds of 5+ Mbps, download speeds of 25+ Mbps, and a ping less than 100MS. Internet speed test results must be submitted with the application. This is a 6-month contract position with the potential for extension or conversion.

This is a Contract position based out of Minnetonka, MN.

The pay range for this position is $38.00 - $45.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Dec 22, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.