Clinical Review Nurse – Concurrent Review

This is a fully remote position, open to applicants in Florida.

📋 Description

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

• Analyze the quality and continuity of care, acuity levels, resource usage, length of stay, and discharge planning.

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

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

• Document and maintain findings from reviews, discharge plans, and actions within health management systems.

• Partner with healthcare providers on medical determinations and service recommendations.

• Educate providers regarding utilization processes.

• Deliver leadership feedback on suitable care levels and medical necessity.

• Review transfer and discharge plans to ensure timely transitions between care levels and facilities.

• Collaborate with care management on member referrals.

• Adhere to all policies and standards while performing additional assigned duties.

⛳️ Requirements

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

• 2–4 years of relevant experience.

• A minimum of 2 years of acute care experience is required.

• Active compact/multi-state nursing licensure in good standing.

• LPN state licensure is required.

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

• Preferred clinical knowledge and ability to assess overall health, treatment needs, and appropriate care levels.

• Familiarity with Medicare and Medicaid regulations is preferred.

• Knowledge of utilization management processes is preferred.

• Ability to work Monday–Friday, 8am–5pm, based on residence time zone.

• Willingness to work rotational weekends and holidays.

🏝️ Benefits

• Competitive pay.

• 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.

• Additional incentives may be incorporated into total compensation.

• Equal opportunity employer dedicated to diversity.