Clinical Review Nurse - Concurrent Review

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

Job summary

A leading healthcare firm seeks a Clinical Review Nurse for concurrent reviews to assess member health and care delivery. The role requires an RN with a bachelor's degree and 2-4 years of experience. The position is remote in Texas, offering competitive benefits including ACA-compliant health insurance and 401K matching.

Benefits

ACA-compliant health benefits

Dental insurance

Vision insurance

401K with matching

Referral bonuses

Paid sick leave

Unpaid sick leave

Qualifications

• 2-4 years of related experience preferred.
• Knowledge of Medicare and Medicaid regulations preferred.

Responsibilities

• Performs concurrent reviews to determine member's overall health.
• Evaluates medical necessity and contributes to discharge planning.
• Collaborates with medical staff and documents findings.

Skills

Multitasking

Fast learner

Computer savvy

Education

Bachelor’s degree in nursing

Job description

Title: Clinical Review Nurse - Concurrent Review

Duration: 6 Months (Possible extension)

Remote - Texas (8am-5pm CST)

Description

Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists in evaluating inpatient services to validate the necessity and setting of care being delivered to the member.

Education/Experience

Requires graduation from an accredited school of nursing or a bachelor’s degree in nursing, with 2 – 4 years of related experience. Clinical knowledge and ability to determine overall health of the member, including treatment needs and appropriate level of care, are preferred. Knowledge of Medicare and Medicaid regulations, as well as utilization management processes, is preferred.

License/Certification

RN - Registered Nurse, State Licensure required. Performs concurrent reviews to ensure appropriate care and setting, reviews quality and continuity of care, collaborates with medical staff, and documents findings in health management systems. Works with healthcare providers to approve or recommend services, educates providers on utilization processes, and provides feedback for improvement. Reviews discharge plans and collaborates on referrals. Performs other duties as assigned.

Additional Requirements

• Must have: Multitasking skills, fast learner, positive attitude, computer savvy.
• Nice to have: Flexible, knowledge of Ambetter.
• Disqualifiers: Less than 2 years of nursing experience, no LPNs.
• Performance indicators: Quality work and meeting productivity expectations.

Hard Skills (Top 3)

1. Multitasking
2. Fast learner
3. Computer savvy

About Us

SPECTRAFORCE is a rapidly growing workforce solutions firm in the U.S., committed to diversity and building strong relationships with clients and candidates. We serve over 150 Fortune clients globally with innovative staffing solutions.

Benefits

Offers ACA-compliant health benefits, dental, vision, accident, critical illness, voluntary life, hospital indemnity insurances, commuter benefits, 401K with matching, and referral bonuses. Unpaid and paid sick leave are also provided.

Equal Opportunity Employer

SPECTRAFORCE is committed to equal employment opportunity and does not discriminate based on protected categories. Reasonable accommodations available upon request.

Additional Notices

California and LA County applicant notices regarding privacy laws, background checks, and employment conditions are provided, ensuring compliance with local and state regulations.