Clinical Review Nurse - Concurrent Review

Spectraforce Technologies, Inc.; Jackson (MS); Remote; USD 65,000 - 85,000; Full time

Job summary

Spectrumforce Technologies, Inc. is seeking a Clinical Review Nurse - Concurrent Review for a 3-month contract to hire. The role is remote with work location listed as Remote-MS CST, schedule 8 am-5 pm Central time, with occasional weekend rotation.

You will perform concurrent reviews, evaluate medical necessity, and contribute to discharge planning according to care policies. The position requires an Associate degree, RN license in MS or a compact state, and at least 2 years of experience.

Qualifications

• RN licensure in MS or Compact
• 2 years of RN experience required
• Associate degree required; Bachelor preferred
• Disqualifier: LPN
• Flexible, results oriented

Responsibilities

• Performs concurrent reviews of member for appropriate care and setting
• Reviews quality and continuity of care including acuity level and discharge planning
• Collaborates with Medical Affairs/Medical Directors to discuss member care
• Documents findings and discharge plans in health management systems
• Assists providers with utilization decisions and education on processes
• Provides feedback to leadership to improve care at appropriate levels
• Reviews transfer or discharge plans to ensure timely transitions
• Collaborates with care management on member referrals
• Performs other duties as assigned
• Complies with all policies and standards

Skills

Basic Computer Knowledge

Critical Thinking Skills

Time Management/Organized

Education

Associate degree

Bachelor

Job description

Position Title

Clinical Review Nurse - Concurrent Review

Work Location

Remote-MS CST

Assignment Duration

3 Months Contract to Hire

Work Schedule

8 am-5 pm (Central). OT is voluntary; weekend rotation once every 2 months

Work Arrangement

Remote

Position Summary

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 evaluating inpatient services to validate the necessity and setting of care being delivered to the member.

Background & Context

The Utilization Management team review members who are currently receiving inpatient services to ensure that care remains medically necessary, appropriate, and provided at the correct level of care. The review nurse assesses the member's clinical status, perform continued stay reviews, facilitate discharge planning and promote timely, appropriate care. The need is driven by needing to backfill FTE positions.

Key Responsibilities

• Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care
• Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member
• Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered
• Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines
• Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings
• Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members
• Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines
• Reviews member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities
• Collaborates with care management on referral of members as appropriate
• Performs other duties as assigned
• Complies with all policies and standards

Qualification & Experience

Candidate Requirements

Education/Certification

Required: Associate degree

Preferred: Bachelor

Licensure

Required: Registered Nurse License (MS or Compact)

Preferred: RN License

Years of experience required: 2 years

Disqualifiers: LPN

Additional qualities to look for: Flexible, Results oriented

Top 3 must-have hard skills stack-ranked by importance

• 1 Basic Computer Knowledge
• 2 Critical Thinking Skills
• 3 Time Management/Organized