Clinical Review Nurse – Concurrent Review

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

📋 Description

• Conduct concurrent assessments to evaluate members’ overall health, appropriateness of care, and required level of care.

• Examine the quality and continuity of care, acuity levels, resource utilization, length of stay, and planning for discharge.

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

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

• Partner with healthcare providers to approve medical determinations or offer recommendations.

• Educate providers on the utilization processes.

• Provide leadership with feedback on areas for improvement in care levels and medical necessity.

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

• Work together with care management on member referrals.

• Adhere to all policies and standards.

• Carry out additional duties as assigned.

⛳️ Requirements

• Graduated from an Accredited School of Nursing or obtained a Bachelor’s degree in Nursing.

• 2–4 years of relevant experience.

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

• LPN state licensure is mandatory.

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

• Experience in a hospital setting, particularly in Emergency Departments or acute care, is preferred.

• An unencumbered compact nursing license and Michigan nursing licensure is preferred.

• Clinical expertise to assess overall health, treatment requirements, and suitable levels of care is preferred.

• Familiarity with Medicare and Medicaid regulations is preferred.

• Knowledge of utilization management processes is preferred.

• Preference for applicants residing in the Central or Eastern Time Zones.

• Availability from Monday to Friday, 8 am to 5 pm in the resident time zone, with rotational weekends and holidays.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off along with holidays.

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

• Additional incentive forms may be included in total compensation.

• Equal opportunity employer dedicated to diversity.