Actalent
LVN- Hybrid
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, telephonic review and participate in interdisciplinary case reviews
Escalate complex or ambiguous cases to the Health Medical Director or Physician Reviewer
Ensure complete, accurate, and compliant documentation in alignment with CMS standards
Monitor daily inpatient census for 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 Health documentation standards
Performs related duties consistent with the scope and intent of the position
Adhere to all departmental performance metrics (turnaround times, quality standards, productivity)
Attend educational sessions and training to stay current with Medicare UM requirements and policies
Regularly update job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations
Participate in interdisciplinary team meetings and represent the UM department effectively
Requirements
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 but not required
Background in concurrent review or inpatient census oversight preferred
Strong critical thinking, communication, and clinical documentation skills
Excellent communication skills, including both oral and written
Excellent active listening and critical thinking and analytical skills
Ability to solve mid‑level problems with minimal supervision
Ability to multi‑task, exercise excellent time management, and meet multiple deadlines
Excellent attention to detail and ability to document information accurately
Ability to effectively and positively work in a dynamic, fast‑paced team environment and achieve objectives
Must have mid‑level skills in Microsoft software (Word, Excel, PowerPoint, Visio) and Access is a plus
Must have the ability to quickly learn and use new software tools
Additional Skills & Qualifications
CA LVN License Required
Work Environment The position is hybrid, 2 days onsite per week in Sacramento, and must be flexible with day selection.
Job Type & Location This is a Contract position based out of Sacramento, CA.
Pay and Benefits
Pay range: $38.00 - $43.00/hr
Eligibility requirements apply to some benefits and may depend on job classification and length of employment
If eligible, benefits available for this temporary role may include: 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 Type This is a fully remote position.
Application Deadline This position is anticipated to close on Jan 16, 2026.
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 .
#J-18808-Ljbffr
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, telephonic review and participate in interdisciplinary case reviews
Escalate complex or ambiguous cases to the Health Medical Director or Physician Reviewer
Ensure complete, accurate, and compliant documentation in alignment with CMS standards
Monitor daily inpatient census for 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 Health documentation standards
Performs related duties consistent with the scope and intent of the position
Adhere to all departmental performance metrics (turnaround times, quality standards, productivity)
Attend educational sessions and training to stay current with Medicare UM requirements and policies
Regularly update job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations
Participate in interdisciplinary team meetings and represent the UM department effectively
Requirements
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 but not required
Background in concurrent review or inpatient census oversight preferred
Strong critical thinking, communication, and clinical documentation skills
Excellent communication skills, including both oral and written
Excellent active listening and critical thinking and analytical skills
Ability to solve mid‑level problems with minimal supervision
Ability to multi‑task, exercise excellent time management, and meet multiple deadlines
Excellent attention to detail and ability to document information accurately
Ability to effectively and positively work in a dynamic, fast‑paced team environment and achieve objectives
Must have mid‑level skills in Microsoft software (Word, Excel, PowerPoint, Visio) and Access is a plus
Must have the ability to quickly learn and use new software tools
Additional Skills & Qualifications
CA LVN License Required
Work Environment The position is hybrid, 2 days onsite per week in Sacramento, and must be flexible with day selection.
Job Type & Location This is a Contract position based out of Sacramento, CA.
Pay and Benefits
Pay range: $38.00 - $43.00/hr
Eligibility requirements apply to some benefits and may depend on job classification and length of employment
If eligible, benefits available for this temporary role may include: 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 Type This is a fully remote position.
Application Deadline This position is anticipated to close on Jan 16, 2026.
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 .
#J-18808-Ljbffr