Clinical Review Nurse – Concurrent Review

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

📋 Description

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

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

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

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

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

• Educate providers on utilization processes.

• Offer leadership insights on areas for enhancing 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.

• Perform additional duties as assigned.

⛳️ Requirements

• Must be a resident of North Carolina.

• Graduate from an Accredited School of Nursing 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.

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

• Familiarity with Medicare and Medicaid regulations is preferred.

• Knowledge of utilization management processes is preferred.

• State licensure as an LPN (Licensed Practical Nurse) is required.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

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

• Additional incentive opportunities may be included in total compensation.

• Equal opportunity employer dedicated to fostering diversity.