Lensa

Utilization Review

Posted: 12 minutes ago

Job Description

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Actalent. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice.Utilization Review (Registered Nurse)Job DescriptionThis role involves performing precertification and medical necessity reviews for designated referrals and targeted outpatient procedures, services, and inpatient admissions. The position requires telephonic reviews to assess medical necessity using established criteria and guidelines, as well as conducting retrospective emergency department reviews. Additional responsibilities include performing eligibility and benefit reviews, identifying patients for case management, conducting quality improvement reviews, and maintaining communication with various healthcare professionals and departments.ResponsibilitiesCarry out precertification and medical necessity reviews for designated referrals. Perform telephonic reviews for medical necessity of targeted outpatient procedures, services, and inpatient admissions. Conduct retrospective emergency department reviews. Perform eligibility and benefit reviews as necessary. Identify patients for case management. Conduct quality improvement reviews. Communicate with inpatient care coordinators, case managers, SNF/Rehab care coordinators, members, providers, Customer Service, Claims, Contracts and Benefits - Appeals, and Risk Management. Essential SkillsRegistered Nurse (RN) with a valid license in GA or Compact. 1+ years of experience in Utilization Management (UM). 1+ years of experience in managed care. Additional Skills & QualificationsExperience with MCG or Interqual is preferred. Utilization review experience is a plus. Job Type & LocationThis is a Contract position based out of Atlanta, GA.Pay and BenefitsThe pay range for this position is $35.00 - $41.00/hr.RequirementsEligibility 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 TypeThis is a fully onsite position in Atlanta,GA.Application DeadlineThis position is anticipated to close on Dec 7, 2025.About ActalentActalent 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 (%20actalentaccommodation@actalentservices.com) for other accommodation options.If you have questions about this posting, please contact support@lensa.com

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