Clinical Review Nurse - Concurrent Review - Remote

Overview

As a Clinical Review Nurse on our Medical Management/Health Services team, you will play a vital role in evaluating member care and ensuring appropriate health services are delivered.

In Short

• Perform concurrent reviews to assess member health and care delivery.
• Evaluate medical necessity and contribute to discharge planning.
• Collaborate with Medical Affairs and healthcare providers.
• Document and maintain review findings in health management systems.
• Provide education to providers on utilization processes.
• Review transfer or discharge plans for timely transitions.
• Work in a hybrid role involving outpatient services.
• Requires RN licensure, with preferred experience in various health services.
• Full-time position with a Monday to Friday schedule.
• Competitive pay and comprehensive benefits offered.

Requirements

• Graduate from an Accredited School of Nursing.
• 2-4 years of related experience required.
• 2+ years of acute care experience preferred.
• Knowledge of Medicare and Medicaid regulations preferred.
• Licensed Practical Nurse (LPN) or Registered Nurse (RN) licensure required.
• Clinical knowledge of treatment needs and care levels.
• Ability to work collaboratively with healthcare providers.
• Experience in adult, pediatric, maternity, and behavioral health preferred.
• On-call rotation for weekends required.
• Strong documentation and communication skills.

Benefits

• Competitive pay with a flexible approach to work.
• Health insurance and 401K plans available.
• Tuition reimbursement programs.
• Paid time off plus holidays.
• Diversity and equal opportunity employer.
• Support for candidate journey and accommodations.
• Access to high-quality healthcare programs.
• Incentives based on skills and experience.
• Commitment to helping people live healthier lives.
• Valued diversity in the workplace.