Clinical Review Nurse - Concurrent Review

SPECTRAFORCE; Austin (TX); Remote; USD 70,000 - 90,000; Full time

Job summary

A rapidly growing workforce solutions company is seeking a Clinical Review Nurse to perform concurrent reviews and collaborate with healthcare providers. This remote role requires a Texas RN License and experience in nursing. Join a diverse team committed to high-quality care and inclusivity.

Benefits

Health Benefits

Dental

Vision

401K

Qualifications

• 2-4 years of related experience in nursing.
• Texas RN License or Compact State RN License required.

Responsibilities

• Perform concurrent reviews to assess member's health and care type.
• Collaborate with healthcare providers on member care plans.
• Complete authorization reviews within a 24-hour turnaround.

Skills

Communication

Documentation

Computer Skills

Education

Bachelor's degree in Nursing

Tools

Microsoft Excel

Job description

Clinical Review Nurse - Concurrent Review

Join to apply for the Clinical Review Nurse - Concurrent Review role at SPECTRAFORCE.

Job Details

• Location: Remote - TX
• Duration: 06 Months (Contract to Hire?)
• Shift: Monday-Friday (8am-5pm) CST

Responsibilities

• Perform concurrent reviews to assess member's overall health, care type, medical necessity, and discharge planning according to policies and guidelines.
• Evaluate inpatient services for necessity and appropriateness of care setting.
• Collaborate with healthcare providers and medical staff to discuss and validate member care plans.
• Document and maintain review findings, discharge plans, and actions in health management systems.
• Work with medical directors and other teams to discuss member care and provide recommendations.
• Assist in educating providers on utilization processes and ensure high-quality care.
• Review transfer or discharge plans for timeliness and appropriateness.
• Complete authorization reviews within a 24-hour turnaround time, handling about 12-20 authorizations daily, with a productivity goal of 2.49-3.21.

Qualifications

• Graduate from an accredited nursing school or Bachelor's degree in Nursing with 2-4 years of related experience.
• Texas RN License or Compact State RN License required.
• Experience in ICU, ER, Utilization Management, or related fields preferred.
• Strong computer, documentation, and communication skills, with proficiency in Microsoft Excel.

Additional Information

• Training includes onboarding, shadowing, and a learning journey covering Trucare Classic, Interqual reviews, and Ambetter line of business.
• Must complete enterprise compliance courses timely.

About Us & Benefits

SPECTRAFORCE is a rapidly growing, diversity-owned workforce solutions company offering health benefits, dental, vision, 401K, and more. We are an equal opportunity employer committed to inclusivity and compliance with privacy laws.