Clinical Review Nurse – Concurrent Review

Pyramid Consulting, Inc; Town of Texas (WI); Remote; Full time

Job summary

A leading healthcare provider seeks a Clinical Review Nurse for a remote contract position. The role involves performing concurrent reviews, collaborating with medical teams, and ensuring compliance with care standards. Ideal candidates will have a nursing degree and relevant experience.

Benefits

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Qualifications

• 2+ years as an RN.
• Graduate from an accredited nursing school.

Responsibilities

• Perform concurrent reviews and assess member's overall health.
• Collaborate with Medical Affairs regarding member care.
• Document and maintain review findings in health management systems.

Skills

Concurrent Review

multitasking

computer literacy

Education

Bachelor’s degree in nursing

Job description

Clinical Review Nurse – Concurrent Review

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Pyramid Consulting, Inc provided pay range

This range is provided by Pyramid Consulting, Inc. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$35.00/hr - $39.00/hr

Immediate need for a talented Clinical Review Nurse – Concurrent Review. This is a 06+months contract to hire opportunity with long-term potential and is located in TX (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-71195

Pay Range: $35 - $39/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Shift Time & Working Days: Mon-Fri 8am-5pm CST
• Perform concurrent reviews, including assessing member's overall health, reviewing care being delivered, evaluating medical necessity, and contributing to discharge planning according to policies and guidelines.
• Assist in evaluating inpatient services to validate the necessity and setting of care.
• Review member's care to determine appropriateness and level of care.
• Review quality and continuity of care by assessing acuity level, resource use, length of stay, and discharge plans.
• Collaborate with Medical Affairs and/or Medical Directors regarding member care.
• Document and maintain review findings, discharge plans, and actions in health management systems per policies.
• Work with healthcare providers to approve or recommend services based on review findings.
• Educate providers on utilization processes to ensure high-quality, appropriate care.
• Provide feedback for process improvements related to care levels and medical necessity.
• Review transfer or discharge plans for timeliness and appropriateness.
• Coordinate with care management on referrals.
• Perform additional duties as assigned and ensure compliance with policies.
• Work from a task queue and meet daily deadlines, collaborating closely with team members.
• Review cases for medical necessity throughout the workday.
• Work remotely with multiple monitors and multitask effectively.
• Post-training, work one Saturday every other month.
• Maintain quality and productivity standards.

Key Requirements and Technology Experience:

• Skills: Concurrent Review, multitasking, quick learner, positive attitude, computer literacy.
• Experience: 2+ years as an RN.
• Education: Graduate from an accredited nursing school or possess a bachelor’s degree in nursing with 2-4 years of related experience.
• Knowledge: Clinical assessment, treatment needs, appropriate care levels, Medicare/Medicaid regulations (preferred), utilization management processes (preferred).
• Licensure: RN license in Texas required.
• Additional: Flexible, knowledgeable about Ambetter, no LPN experience required, minimum 2 years nursing experience.

Our client is a leading healthcare provider. Interested candidates should apply online for immediate consideration.

Pyramid Consulting, Inc. is an equal opportunity employer and prohibits discrimination in all employment practices.

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