Clinical Review Nurse - Concurrent Review - Remote

Overview

This position involves performing concurrent reviews to evaluate the overall health of members and the appropriateness of care being delivered, contributing to discharge planning, and collaborating with healthcare providers.

In Short

• Perform concurrent reviews of member health and care.
• Evaluate medical necessity and discharge planning.
• Collaborate with Medical Affairs and Medical Directors.
• Document findings in health management systems.
• Educate providers on utilization processes.
• Provide feedback for improvement opportunities.
• Review transfer and discharge plans for timely actions.
• Comply with all policies and standards.
• Work in a flexible environment with remote options.
• Assist with other duties as assigned.

Requirements

• Graduation from an Accredited School of Nursing or Bachelor’s degree in Nursing.
• 2-4 years of related experience required.
• 2+ years of acute care experience preferred.
• Clinical knowledge to determine treatment needs.
• Knowledge of Medicare and Medicaid regulations preferred.
• Utilization management processes knowledge preferred.
• NICU experience highly preferred.
• LPN or RN state licensure required.

Benefits

• Competitive pay and health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules (remote, hybrid, field, or office).