Clinical Review Nurse - Concurrent Review REMOTE

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 Clinical Review Nurse will perform concurrent reviews to assess the member's overall health, evaluate the type of care being delivered, and determine medical necessity. This role also involves contributing to discharge planning according to established care policies and guidelines. The position requires assisting in evaluating inpatient services to validate the necessity and setting of care. The nurse will be responsible for generating denial letters for concurrent reviews, but no member or provider outreach is required.

Conduct concurrent reviews to determine the member's overall health. Review the type of care being delivered and assess medical necessity. Contribute to discharge planning according to care policies and guidelines. Assist in evaluating inpatient services to validate the necessity and setting of care. Generate denial letters for concurrent reviews. Work with software tools such as TruCare Classic, Excel, Outlook, Word, and OneNote.