Utilization Review - Registered Nurse
Job Description
This 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.
Responsibilities
Carry 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 Skills
Registered 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 & Qualifications
Experience with MCG or Interqual is preferred.Utilization review experience is a plus.Job Type & LocationThis is a Contract position based out of Duluth, GA.
Pay and BenefitsThe pay range for this position is $40.00 - $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)
Workplace TypeThis is a fully onsite position in Duluth,GA.
Application DeadlineThis position is anticipated to close on Jan 22, 2026.
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 for other accommodation options.
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ResponsibilitiesLead in the concepting and design of products that provide solutions to customer and market needs.Collaborate with the development team to create new products.Ensure compatibility of developed products with current and future manufacturing operations.Meet competitive and market demands for performance and cost in product development.Specify and develop sequences of operations for automated equipment.Prepare schematics and specifications for control panel fabrication.Develop Programmable Logic Control (PLC) programs.Maintain product development schedules and cost estimates.Adhere to established engineering standards and best practices, including software revision control.Perform prototype development and testing.Conduct on-site beta testing to ensure safety, reliability, and performance metrics are met.Investigate field product issues and determine root causes.Travel domestically up to 40% in North America, primarily within the Continental United States.Essential SkillsBachelor’s degree in electrical engineering or a related field, or equivalent experience.Minimum of 6 years of related experience.Experience with sortation and conveyance equipment or robotics design.Proficiency in control software and tools.Knowledge of electrical and safety codes for machine and equipment design, including risk assessments.Additional Skills & QualificationsStrong knowledge of industrial automation systems, including HMI, SCADA, controls/controllers, and PLCs.Proficient with AutoCAD and AutoCAD Electrical or similar CAD systems such as EPlan.Excellent verbal and written communication skills.Ability to lead a team and accomplish project goals effectively.Multi-tasking capability with attention to detail and deadlines.Team-oriented and collaborative with creative-thinking and problem-solving skills.Ability to learn new technologies and self-motivation.Flexibility to work non-traditional hours.Work EnvironmentThis is a hybrid position that may require up to 50% domestic travel. We seek an individual comfortable with high travel demands and capable of working in non-traditional hours. The role offers an opportunity to grow with a well-known national company in the material handling space.
Job Type & LocationThis is a Permanent position based out of Erlanger, KY.
Pay and BenefitsThe pay range for this position is $125000.00 - $135000.00/yr.
3 Weeks PTO, 7 sick days, 2 floating holidays, 401k with a match (4%) and HSA/FSA program if they choose the plan that includes this, eligible for benefits day 1
Workplace TypeThis is a hybrid position in Erlanger,KY.
Application DeadlineThis position is anticipated to close on Jan 16, 2026.
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 for other accommodation options.
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