Utilization Review Nurse

Remote Utilization Review RN | CA RN License Required - -Must sit in CA Were seeking an experienced Utilization Review RN for a remote MondayFriday opportunity. This role will review clinical information, apply evidence-based criteria, make first-level determination recommendations, and ensure cases are processed within required regulatory turnaround times. Requirements:

- Active California RN license
- 5+ years of nursing experience
- Inpatient clinical experience
- Utilization Review/Utilization Management experience required
- Experience with Post-Service Review, Prior Authorization, and/or Concurrent Review
- Knowledge of ICD-10 and clinical documentation
- Strong medical necessity/clinical review skills
- Excellent Windows/computer skills and ability to navigate multiple systems
- Strong organization and case-prioritization skills

Responsibilities:

- Complete prospective clinical reviews
- Apply evidence-based guidelines and nationally recognized clinical criteria
- Review diagnoses for appropriate ICD-10 alignment
- Triage urgent and standard cases according to required turnaround times
- Develop approval or denial recommendations
- Escalate denial recommendations to Medical Directors when required
- Communicate determinations to providers and/or members
- Document reviews in accordance with regulatory and accreditation requirements
- Identify potential quality-of-care concerns and treatment/service delays
- Identify potential Third-Party Liability and Coordination of Benefits cases

Schedule: MondayFriday, 8:00 AM5:00 PM Location: Remote
Job Type & Location
This is a Contract position based out of Sacramento, CA.
Pay and Benefits
The pay range for this position is $50.00 - $55.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. 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)
Job Type & Location
This is a Contract position based out of Sacramento, CA.
Application Deadline
This position is anticipated to close on Oct 28, 2026.
Workplace Type
This is a hybrid position in Sacramento,CA. 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 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.

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 process due to a disability,
please email [email protected] for other accommodation options.

San Francisco Fair Chance Ordinance:
Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the
city and county of San Francisco, we will consider for employment qualified applicants
with arrest and conviction records.

Massachusetts Lie Detector:
It is unlawful in Massachusetts to require or administer a lie detector test as a
condition of employment or continued employment. An employer who violates this law
shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI):
We may use Artificial Intelligence (AI) to support parts of our hiring process,
including sourcing, screening, and evaluating candidates. AI helps assess applications
and qualifications, but final decisions are made by our hiring team. By applying, you
acknowledge and agree that your application may be reviewed using AI tools.