Actalent
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Job Title:
Utilization Review RN - Critical Care
Location:
Buckhead, GA (on-site position)
Schedule:
Monday–Friday, 8:30 AM–5:00 PM (Rotating weekends)
About The Role We are seeking a detail-oriented and compassionate
Utilization Review Registered Nurse (RN)
to join our team. In this role, you will ensure appropriate care by conducting
precertification and medical necessity reviews
for referrals, outpatient procedures, and inpatient admissions. You’ll collaborate with healthcare professionals and administrative teams to support quality care and compliance with established guidelines.
Key Responsibilities
Review and approve precertification and medical necessity for designated referrals, procedures, and admissions.
Conduct telephonic reviews for targeted services and procedures.
Perform retrospective emergency department reviews.
Verify eligibility and benefits as needed.
Identify patients for case management programs.
Participate in quality improvement initiatives.
Communicate effectively with care coordinators, case managers, providers, members, and internal teams (claims, benefits, appeals, risk management).
Required Qualifications
Active RN license in Georgia or Compact State – must be local to GA and preferably at a commutable distance from Atlanta.
BSN degree required.
Minimum 1 year of utilization review experience.
Minimum 1 year of managed care experience.
BLS and CPR certifications.
Experience with concurrent, prospective, and retrospective reviews.
Familiarity with MCG and InterQual standards and guidelines.
Preferred Skills & Experience
Knowledge of MCG guidelines.
Proficiency in EPIC electronic health record system.
Previous roles in insurance, inpatient care, and ICU settings.
Job Type & Location This is a Contract position based out of Buckhead, GA.
Pay And Benefits The pay range for this position is $45.00 - $60.00/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)
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.
Application Deadline This position is anticipated to close on Jan 16, 2026.
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Job Title:
Utilization Review RN - Critical Care
Location:
Buckhead, GA (on-site position)
Schedule:
Monday–Friday, 8:30 AM–5:00 PM (Rotating weekends)
About The Role We are seeking a detail-oriented and compassionate
Utilization Review Registered Nurse (RN)
to join our team. In this role, you will ensure appropriate care by conducting
precertification and medical necessity reviews
for referrals, outpatient procedures, and inpatient admissions. You’ll collaborate with healthcare professionals and administrative teams to support quality care and compliance with established guidelines.
Key Responsibilities
Review and approve precertification and medical necessity for designated referrals, procedures, and admissions.
Conduct telephonic reviews for targeted services and procedures.
Perform retrospective emergency department reviews.
Verify eligibility and benefits as needed.
Identify patients for case management programs.
Participate in quality improvement initiatives.
Communicate effectively with care coordinators, case managers, providers, members, and internal teams (claims, benefits, appeals, risk management).
Required Qualifications
Active RN license in Georgia or Compact State – must be local to GA and preferably at a commutable distance from Atlanta.
BSN degree required.
Minimum 1 year of utilization review experience.
Minimum 1 year of managed care experience.
BLS and CPR certifications.
Experience with concurrent, prospective, and retrospective reviews.
Familiarity with MCG and InterQual standards and guidelines.
Preferred Skills & Experience
Knowledge of MCG guidelines.
Proficiency in EPIC electronic health record system.
Previous roles in insurance, inpatient care, and ICU settings.
Job Type & Location This is a Contract position based out of Buckhead, GA.
Pay And Benefits The pay range for this position is $45.00 - $60.00/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)
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.
Application Deadline This position is anticipated to close on Jan 16, 2026.
#J-18808-Ljbffr