Clinical Review Nurse – Concurrent Review

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

📋 Description

• Conduct concurrent evaluations to assess members' overall health, suitable care, and level of care.

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

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

• Gather, document, and preserve findings from concurrent reviews, 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 opportunities to enhance the level of care and medical necessity.

• Review 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 while performing other assigned tasks.

⛳️ Requirements

• Must be a graduate from an Accredited School of Nursing or possess a Bachelor’s degree in Nursing.

• 2–4 years of relevant experience is required.

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

• Clinical knowledge and the ability to assess the overall health of members, including treatment needs and appropriate levels of care, are preferred.

• Familiarity with Medicare and Medicaid regulations is preferred.

• Understanding of utilization management processes is preferred.

• LPN — Licensed Practical Nurse — State Licensure is required.

• RN — Registered Nurse — State Licensure and/or Compact State Licensure for the State of Nevada is required.

• Ideally, a minimum of 3 years of neonatal level II or IV NICU experience.

• NICU certification is an advantage.

• Preferred compact nursing licensure or the ability to obtain licensure in other states, such as CA, OR, IL, MI, or NV.

• Must be available Monday to Friday, 8 am to 5 pm based on the applicant’s residence time zone, including rotational weekends and holidays.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off along with holidays.

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

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