Actalent
Actalent is seeking a Licensed Vocational Nurse (LVN) to provide remote utilization review and inpatient nursing support for our managed care program in the Sacramento area. The role is a contract position, based out of Sacramento, CA, and requires candidates to reside within 50 miles of this location.
Job Duties
Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and discharges.
Apply CMS regulations and evidence-based criteria (MCG, InterQual) to evaluate medical necessity.
Collaborate with hospital teams, providers, IPA case managers, and health plan representatives.
Conduct in‑person hospital rounds 2–3 days per week and participate in interdisciplinary case reviews.
Escalate complex or ambiguous cases to the Vivant Health Medical Director or Physician Reviewer.
Ensure complete, accurate, and compliant documentation aligned with CMS and Vivant Health standards.
Monitor daily inpatient census for Vivant Health–managed members across contracted hospitals.
Support discharge planning and identify post‑acute needs including SNF, rehab, home health, or DME.
Communicate avoidable days, delays in care, and readmission risks to UM leadership.
Participate in audit readiness, quality improvement projects, and performance reporting.
Educate providers and facilities on Medicare UM criteria and Vivant Health documentation standards.
Perform related duties consistent with the scope and intent of the position.
Essential Skills
3+ years of inpatient hospital nursing experience (e.g., med‑surg, telemetry, ICU).
At least 1 year of experience in utilization review, case management, or hospital discharge planning.
Familiarity with CMS inpatient criteria, including the Two‑Midnight Rule.
Proficiency in Microsoft Office and electronic medical record (EMR) systems.
Previous experience with IPA, MSO, or delegated managed care environments preferred.
Working knowledge of EZ‑CAP, EZ‑Net, InterQual, and MCG preferred.
Certified Case Manager (CCM), CPUR, or CPHM credential preferred.
Background in concurrent review or inpatient census oversight preferred.
Strong critical thinking, communication, and clinical documentation skills.
Excellent oral and written communication skills.
Excellent active listening and analytical skills.
Ability to solve mid‑level problems with minimal supervision.
Ability to multi‑task, exercise excellent time management, and meet multiple deadlines.
Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers and members.
Ability to provide and receive constructive job and industry‑related feedback.
Ability to maintain confidentiality and share information on a need‑to‑know basis.
Ability to consistently deliver excellent customer service.
Excellent attention to detail and ability to document information accurately.
Ability to work effectively in a dynamic, fast‑paced team environment and achieve objectives.
Demonstrate commitment to the organization’s mission.
Mid‑level skills in Microsoft software (Word, Excel, PowerPoint, Visio) and Access is a plus.
Typing speed of 40 wpm or more is a plus.
Ability to quickly learn and use new software tools.
Mid‑level skills using e‑mail applications.
Self‑motivated with strong organizational, multi‑tasking, planning, and follow‑up skills.
Ability to work independently as well as in a team environment.
Ability to present self in a professional manner and represent the company image.
Additional Skills & Qualifications
Must hold a valid CA LVN license.
Work Environment This position offers a remote work opportunity with a standard Monday to Friday day shift. The role is based in an office setting at the corporate location, providing dual screens to enhance productivity.
Job Type & Location Contract position based out of Sacramento, CA.
Pay And Benefits Pay range: $38.00 – $43.00 per hour.
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)
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 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.
Seniority Level Mid‑Senior level
Employment Type Contract
Job Function Health Care Provider
Industries Business Consulting and Services
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Job Duties
Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and discharges.
Apply CMS regulations and evidence-based criteria (MCG, InterQual) to evaluate medical necessity.
Collaborate with hospital teams, providers, IPA case managers, and health plan representatives.
Conduct in‑person hospital rounds 2–3 days per week and participate in interdisciplinary case reviews.
Escalate complex or ambiguous cases to the Vivant Health Medical Director or Physician Reviewer.
Ensure complete, accurate, and compliant documentation aligned with CMS and Vivant Health standards.
Monitor daily inpatient census for Vivant Health–managed members across contracted hospitals.
Support discharge planning and identify post‑acute needs including SNF, rehab, home health, or DME.
Communicate avoidable days, delays in care, and readmission risks to UM leadership.
Participate in audit readiness, quality improvement projects, and performance reporting.
Educate providers and facilities on Medicare UM criteria and Vivant Health documentation standards.
Perform related duties consistent with the scope and intent of the position.
Essential Skills
3+ years of inpatient hospital nursing experience (e.g., med‑surg, telemetry, ICU).
At least 1 year of experience in utilization review, case management, or hospital discharge planning.
Familiarity with CMS inpatient criteria, including the Two‑Midnight Rule.
Proficiency in Microsoft Office and electronic medical record (EMR) systems.
Previous experience with IPA, MSO, or delegated managed care environments preferred.
Working knowledge of EZ‑CAP, EZ‑Net, InterQual, and MCG preferred.
Certified Case Manager (CCM), CPUR, or CPHM credential preferred.
Background in concurrent review or inpatient census oversight preferred.
Strong critical thinking, communication, and clinical documentation skills.
Excellent oral and written communication skills.
Excellent active listening and analytical skills.
Ability to solve mid‑level problems with minimal supervision.
Ability to multi‑task, exercise excellent time management, and meet multiple deadlines.
Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers and members.
Ability to provide and receive constructive job and industry‑related feedback.
Ability to maintain confidentiality and share information on a need‑to‑know basis.
Ability to consistently deliver excellent customer service.
Excellent attention to detail and ability to document information accurately.
Ability to work effectively in a dynamic, fast‑paced team environment and achieve objectives.
Demonstrate commitment to the organization’s mission.
Mid‑level skills in Microsoft software (Word, Excel, PowerPoint, Visio) and Access is a plus.
Typing speed of 40 wpm or more is a plus.
Ability to quickly learn and use new software tools.
Mid‑level skills using e‑mail applications.
Self‑motivated with strong organizational, multi‑tasking, planning, and follow‑up skills.
Ability to work independently as well as in a team environment.
Ability to present self in a professional manner and represent the company image.
Additional Skills & Qualifications
Must hold a valid CA LVN license.
Work Environment This position offers a remote work opportunity with a standard Monday to Friday day shift. The role is based in an office setting at the corporate location, providing dual screens to enhance productivity.
Job Type & Location Contract position based out of Sacramento, CA.
Pay And Benefits Pay range: $38.00 – $43.00 per hour.
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)
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 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.
Seniority Level Mid‑Senior level
Employment Type Contract
Job Function Health Care Provider
Industries Business Consulting and Services
#J-18808-Ljbffr