Clinical Care Reviewer II

Clinical Care Reviewer II - 100% Remote JOB DESCRIPTIONThe Clinical Care Reviewer II is responsible for processing medical necessity reviews to determine the appropriateness of authorization for healthcare services. This role is crucial in assisting with discharge planning activities, including durable medical equipment and home health services, and coordinating care for members. The position involves monitoring the delivery of healthcare services to ensure they are cost-effective and comply with state and federal regulations, contracts, and accreditation standards. Key responsibilities include conducting various types of reviews, coordinating care, referring cases to medical directors, identifying quality issues, and supporting non-clinical medical management staff.QualificationsLicensure and Certification: Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice is required. Must have Multi State or Ohio LicenseEducation and Experience: Completion of an accredited registered nursing (RN) degree program is required Minimum of three (3) years clinical experience is required Med/surgical, emergency acute clinical care or home health experience is preferred Medical management experience is preferred Medicaid/Medicare/Commercial experience is preferredAbout 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.Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

Hiring diverse talent

Maintaining an inclusive environment through persistent self-reflection

Building a culture of care, engagement, and recognition with clear outcomes

Ensuring growth opportunities for our people

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 actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.