Clinical Review Nurse – Concurrent Review

This is a fully remote position, open to applicants in Arizona, +3 more states.

📋 Description

• Conduct concurrent reviews to assess members’ overall health, suitability of care, and necessary level of care.

• Analyze acuity, resource utilization, duration of stay, quality and continuity of care, along with discharge planning.

• Assess inpatient services to confirm medical necessity and appropriate care settings.

• Collaborate with Medical Affairs and/or Medical Directors concerning member care.

• Gather, document, and preserve review findings, discharge plans, and actions within health management systems.

• Partner with healthcare providers to endorse medical decisions or propose recommendations.

• Educate providers on utilization management processes.

• Offer leadership insights on areas for enhancing level of care and medical necessity.

• Evaluate transfer and discharge plans to facilitate timely transitions across care levels and facilities.

• Work alongside care management in processing member referrals.

• Undertake additional assigned tasks while adhering to policies and standards.

⛳️ Requirements

• Graduate from an accredited School of Nursing or possess a Bachelor’s degree in Nursing.

• 2–4 years of relevant experience.

• Minimum of 2 years of acute care experience is mandatory.

• Clinical expertise and the ability to assess the overall health of a member, including treatment requirements and suitable level of care, are preferred.

• Familiarity with Medicare and Medicaid regulations is preferred.

• Understanding of utilization management processes is preferred.

• LPN state licensure is required.

• RN state licensure and/or Compact State Licensure for the State of Nevada is required.

• RN compact nursing licensure is preferred, or the ability to obtain licensure in other states as required.

• Availability to work Monday–Friday from 8am–5pm based on resident time zone, including rotational weekends and holidays.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Competitive salary.

• Additional incentives may be included in the overall compensation package.

• Company reimbursement for the cost of obtaining licensure in other states.