Concurrent Review Nurse - RN

IMCS; Town of Texas (WI); Remote; Full time

Job summary

A leading healthcare provider is seeking a Clinical Review Nurse for a remote position in Texas. This role involves reviewing care quality, collaborating with medical teams, and ensuring compliance with healthcare regulations. Ideal candidates will have a nursing degree and strong communication skills. This is a contract position with potential for hire after 6 months.

Qualifications

• Knowledge of Medicare and Medicaid regulations preferred.

Responsibilities

• Review quality and continuity of care for members.
• Collaborate with Medical Affairs to discuss member care.
• Document and maintain concurrent review findings.

Skills

Communication

Documentation

Computer Skills

Education

Bachelor’s Degree in Nursing

Graduate from an Accredited Nursing School

Texas RN License

Job description

Job Title: Clinical Review Nurse – Concurrent Review

Duration: 6 months Contract to hire

Location: Remote – Texas

Shift Type: M-F; 8-5 (Every other month will work one Saturday a month)

Pay rate : $40 - $42/hr

Day-to-day responsibilities of this role:

1. Review quality and continuity of care by assessing acuity level, resource utilization, length of stay, and discharge planning for members.
2. Collaborate with Medical Affairs and/or Medical Directors to discuss member care.
3. Document and maintain concurrent review findings, discharge plans, and actions taken in health management systems, following utilization management policies.
4. Work with healthcare providers to approve medical determinations or provide recommendations based on review findings.
5. Educate providers on utilization processes to ensure high-quality, appropriate care.
6. Provide feedback to leadership on opportunities to improve appropriate level of care and medical necessity, based on clinical policies.
7. Review member transfer or discharge plans to ensure timely discharges between care levels and facilities.
8. Collaborate with care management for member referrals as appropriate.

Required Skills/Experience:

• Knowledge of Medicare and Medicaid regulations (preferred).
• Strong computer, documentation, and communication skills.

Education/Certification:

• Graduate from an accredited nursing school or hold a bachelor’s degree in nursing.
• Texas RN License or Compact State License.

Seniority level

• Entry level

Employment type

• Contract

Job function

• Health Care Provider

Industries

• Business Consulting and Services