Job Description
We are seeking a dedicated Clinical Review Nurse to perform concurrent reviews. This role involves determining the overall health of members, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. The position requires working with TruCare Classic, Excel, Outlook, Word, and OneNote.
Responsibilities
Conduct concurrent reviews to assess member's overall health and care type.Evaluate medical necessity and contribute to discharge planning.Assist in evaluating inpatient services to ensure care necessity and appropriate setting.Prepare denial letters for concurrent review without member or provider outreach.Work within TruCare Classic and utilize tools such as Excel, Outlook, Word, and OneNote.Essential Skills
RN License required for the state of residence; Compact License is preferred.2-4 years of related experience with at least 2 years in acute care.Strong skills in clinical review, utilization management, and concurrent review.Self-starter with excellent time management and attention to detail.Additional Skills & Qualifications
Flexibility to adapt to volume shifts in specific areas.Preferred knowledge of Medicare and Medicaid regulations.Preferred understanding of utilization management processes.Work Environment
This is a 100% remote position based on the West Coast, with working hours from Tuesday to Saturday, 10 AM to 7 PM PST. The training schedule is Monday to Friday, 8 AM to 5 PM PST for a two-week course, during which cameras must be on and no time off is allowed. The role may have potential for extension or conversion to a full-time position. Holidays are worked as needed with notice.
Job Type & Location
This is a Contract position based out of Tigard, Oregon.
Must be working in west coast hours!!
Pay and Benefits
The pay range for this position is $35.00 - $42.00/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)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Sep 23, 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.