Job Description

Job Description

Job Description

Actalent is Hiring a Behavioral Health Utilization Review Nurse

Job Description

We are seeking a dedicated Utilization Management Nurse (UMN) who will work collaboratively with an interdisciplinary team under the supervision of the Director and/or Manager/Supervisor of Medical Management. The primary role involves reviewing requests for service authorizations to ensure the utilization of appropriate services, including specialties, medical treatments, elective hospital admissions, rehabilitative services, and more. The UMN will support complex cases, internal process development, and provide education to the team on utilization review-related issues.

Responsibilities

• Review prior authorization requests for medical necessity and appropriateness using standardized Review Criteria.
• Coordinate with the Medical Director/Physicians for requests outside of standard Review Criteria.
• Ensure compliance with federal, state guidelines, and contractual requirements.
• Obtain necessary documentation and ensure completion of assigned caseload.
• Act as a liaison between the Medical Director, physicians, and office staff to resolve prior authorization questions.
• Evaluate and monitor appropriate utilization of resources including durable medical equipment, hospitalizations, and long-term rehabilitation.
• Provide current and timely documentation reflecting department work processes and policy guidelines.
• Promote safe and appropriate coordination of care and optimal utilization of resources.
• Identify and participate in the development of programs, policies, and procedures for continuous quality improvement.
• Maintain confidentiality in accordance with company and department policies.
• Participate in regular departmental training.
• Serve as a plan liaison to coordinate enrollee benefits with providers and external organizations.
• Prepare and present reports on department activities as assigned.

Essential Skills

• Utilization management
• Behavioral Health
• Mental Health
• Clinical review
• Utilization review

Additional Skills & Qualifications

• Current unrestricted Florida RN or LPN License.
• Minimum of one year of utilization review experience and one year of discharge planning experience in an acute care setting.
• Four years of related clinical experience in a healthcare field or equivalent combination of education and experience.
• Valid Florida Driver’s License.
• Knowledge of case management and utilization review concepts, including InterQual and Milliman Criteria, Florida Medicaid Program and CMS Guidelines.
• Proficient in word processing software, spreadsheet software such as Microsoft Excel, and electronic medical record software.
• Knowledgeable regarding community and post-acute resources and related requirements.

Work Environment

This role offers a hybrid work schedule with in-office requirements on Tuesdays in Sunrise from 8:30 AM to 5:00 PM, with a 30-minute lunch break. Training will last between 2-4 weeks, involving shadowing a team member on-site on Tuesdays and remote shadowing through Teams.

Pay and Benefits

The pay range for this position is $35.00 - $38.00/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)

Workplace Type

This is a hybrid position in Sunrise,FL.

Application Deadline

This position is anticipated to close on Oct 28, 2025.

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.

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