Clinical Review Nurse

A-Line Staffing Solutions LLC; Texas; Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Benefits after 90 days

Job summary

A-Line Staffing Solutions LLC is seeking a Clinical Review Nurse to support remote members in the Central Time Zone. This role focuses on concurrent reviews, care appropriateness, and discharge planning, with collaboration across medical affairs and care management teams.

The position requires RN/LPN/LVN licensure, at least 1 year of nursing experience (2+ years acute care preferred), and a compact license. TruCare Cloud and Co-Pilot experience are a plus; remote CST hours apply.

Qualifications

• High school diploma and nursing degree; RN/LPN/LVN compact license required.
• 1+ year nursing experience; 2+ years acute care preferred.
• Bachelor's degree in nursing preferred; accredited nursing program completion

Responsibilities

• Perform concurrent reviews to determine members' health, appropriate care, and level of care.
• Review acuity, resource consumption, length of stay, quality and continuity of care, and discharge planning.
• Collaborate with Medical Affairs, Medical Directors, healthcare providers, and care management teams.
• Document concurrent review findings, discharge plans, and actions in health management systems.
• Educate providers on utilization processes and provide feedback to leadership regarding medical necessity.
• Review transfer and discharge plans to support timely transitions between levels of care and facilities.

Skills

Independent work

Teamwork

Organizational skills

Education

High school diploma

Associate degree in Nursing

Bachelor's degree in Nursing

Tools

TruCare Cloud

Co-Pilot

Job description

Job Title: Clinical Review Nurse

Address: Remote CST

Job Description

Perform concurrent reviews to determine members' overall health, appropriate care, and level of care. Review acuity, resource consumption, length of stay, quality and continuity of care, and discharge planning. Collaborate with Medical Affairs, Medical Directors, healthcare providers, and care management teams regarding member care. Document concurrent review findings, discharge plans, and actions in health management systems. Approve medical determinations or provide recommendations based on requested services and review findings. Educate providers on utilization processes and provide feedback to leadership regarding appropriate care and medical necessity. Review transfer and discharge plans to support timely transitions between levels of care and facilities.

Critical Information

Remote position serving the Central Time Zone. Monday through Friday, 11:00 AM–8:00 PM CST; rotating weekends and holidays may be required according to business needs. A 10-hour, four-day workweek may be available based on alignment with the candidate.

Experience

Experience with Medicaid, managed care organizations, TruCare Cloud, or Co-Pilot is preferred.

Required Skills

Ability to work independently with minimal supervision, along with teamwork and strong organizational skills, is required.

Other Requirements

Computer literacy knowledge assessment required.

Interview Process

Interviews will be conducted through Teams with cameras on.

Education / Licenses Needed

High school diploma and an associate degree or higher in nursing. Compact nursing license as an RN, LPN, or LVN required. Graduation from an accredited school of nursing or a bachelor's degree in nursing preferred. One or more years of experience required; two or more years of acute care experience preferred.

Benefits

Benefits are available to full-time employees after 90 days of employment.