Utilization Review Nurse

Remote Utilization Review RN | CA RN License RequiredWe're seeking an experienced Utilization Review RN for a remote Monday-Friday 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 license5+ years of nursing experienceInpatient clinical experienceUtilization Review/Utilization Management experience requiredExperience with Post-Service Review, Prior Authorization, and/or Concurrent ReviewKnowledge of ICD-10 and clinical documentationStrong medical necessity/clinical review skillsExcellent Windows/computer skills and ability to navigate multiple systemsStrong organization and case-prioritization skillsResponsibilities:Complete prospective clinical reviewsApply evidence-based guidelines and nationally recognized clinical criteriaReview diagnoses for appropriate ICD-10 alignmentTriage urgent and standard cases according to required turnaround timesDevelop approval or denial recommendationsEscalate denial recommendations to Medical Directors when requiredCommunicate determinations to providers and/or membersDocument reviews in accordance with regulatory and accreditation requirementsIdentify potential quality-of-care concerns and treatment/service delaysIdentify potential Third-Party Liability and Coordination of Benefits casesSchedule: Monday-Friday, 8:00 AM-5:00 PMLocation: RemoteJob 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)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 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.