Clinical Review Nurse Concurrent Review

Jobs via Dice; United States; Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare company is seeking a Clinical Review Nurse for Concurrent Review in Texas. This remote position offers a contract-to-hire opportunity with a pay range of $35 - $39/hour and includes benefits like health insurance and 401(k). The role involves performing concurrent reviews, collaborating with healthcare providers, and ensuring quality care standards are met. Candidates must have an RN license in Texas and a minimum of 2 years nursing experience.

Benefits

Health insurance (medical, dental, vision)

401(k)

Paid sick leave

Qualifications

• Minimum 2+ years as an RN.
• Graduate from an accredited nursing school.
• RN license in Texas required.

Responsibilities

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

Skills

Multitasking

Computer Savvy

Knowledge of Medicare and Medicaid

Utilization Management

Education

Bachelor's degree in nursing

Job description

Immediate Opening: Clinical Review Nurse - Concurrent Review

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

Job ID: 25-71195

Pay Range: $35 - $39/hour. Employee benefits include health insurance (medical, dental, vision), 401(k), and paid sick leave (based on location).

Key Responsibilities:

• Shift & Working Days: Mon-Fri, 8 am - 5 pm CST
• 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.
• Review acuity, resource use, length of stay, and discharge plans to ensure quality and continuity of care.
• Collaborate with Medical Affairs and Medical Directors regarding member care.
• Document review findings, discharge plans, and actions in health management systems per policies.
• Work with healthcare providers on medical determinations and recommendations.
• Educate providers on utilization processes to ensure appropriate care quality.
• Provide feedback for improving care levels and medical necessity adherence.
• Review transfer and discharge plans for timeliness and appropriateness.
• Coordinate with care management on referrals.
• Other duties as assigned, complying with all policies and standards.
• Work from a task queue, collaborating with team leads and members to meet deadlines.
• Review cases for medical necessity throughout the workday.
• Remote work setup with multiple monitors and multitasking capabilities.
• Post-training, work one Saturday every other month.
• Performance metrics include quality work and meeting productivity expectations.

Key Requirements & Technology Experience:

• Experience in Concurrent Review as an RN
• Ability to multitask, learn quickly, and be computer savvy
• Minimum 2+ years as an RN
• Graduate from an accredited nursing school or hold a bachelor's degree in nursing with 2-4 years of related experience
• Knowledge of Medicare and Medicaid regulations preferred
• Understanding of utilization management processes preferred
• License: RN license in Texas required
• Flexible, positive attitude; knowledge of Ambetter beneficial
• Disqualifiers: Less than 2 years nursing experience or no LPNs

Our client is a leading player in the Healthcare Industry. We are currently interviewing for this and similar contract roles. Interested candidates should apply online for immediate consideration.

Pyramid Consulting, Inc. is an equal opportunity employer, prohibiting discrimination and harassment of any kind based on race, color, religion, age, sex, national origin, disability, genetics, veteran status, sexual orientation, gender identity, or any other protected characteristic.

By applying, you consent to receiving calls, texts, and emails from Pyramid Consulting, Inc. and affiliates. Message rates may apply. Reply STOP to opt out, HELP for assistance. Privacy policy applies.

Note: AI tools may have been used to generate or enhance this job description. It has been reviewed for accuracy and reflects the current opportunity.