Clinical Review Nurse – Concurrent Review

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

📋 Description

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

• Analyze acuity levels, resource utilization, duration of stay, and discharge planning.

• Collaborate with Medical Affairs and/or Medical Directors to discuss the care of members.

• Gather, document, and maintain findings from reviews, discharge plans, and actions in health management systems.

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

• Educate providers regarding utilization processes.

• Provide feedback to leadership on potential improvements in care levels and medical necessity.

• Examine transfer or discharge plans to ensure timely transitions between different levels of care and facilities.

• Work closely with care management on member referrals.

• Adhere to all policies and standards while performing other assigned responsibilities.

⛳️ Requirements

• Graduate from an accredited nursing program or hold a Bachelor’s degree in Nursing.

• 2–4 years of relevant experience.

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

• Valid Iowa nursing license or a compact nursing license.

• State licensure as a Licensed Practical Nurse (LPN) is mandatory.

• Preferred clinical knowledge and ability to assess overall health of members, including treatment requirements and appropriate care levels.

• Familiarity with Medicare and Medicaid regulations is preferred.

• Understanding of utilization management processes is preferred.

• Must be available to work Monday–Friday, from 8am to 5pm Central.

• Required participation in a rotating weekend and holiday schedule.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work options with remote, hybrid, field, or office schedules.

• Competitive salary.