LTC RN (Registered Nurse)

BCforward; Austin (TX); Remote; USD 48,000 - 56,000; Full time

Job summary

BCforward is seeking an RN to join our Health Clinical Services team on a 9-month contract in Austin. The ideal candidate will perform medical necessity reviews for long-term care submissions, evaluate Medicaid criteria, and provide clinical call support to providers and members by phone.

You will review documentation, render determinations with proper rationale, participate in hearings as assigned, and help escalate and resolve issues while maintaining thorough records.

Qualifications

• Unrestricted Registered Nurse license.
• High School Diploma or GED.
• Demonstrated success in team-oriented environments.
• Creative and analytical problem-solving abilities.
• Desire to work in an information systems environment.
• Excellent leadership, written and oral communication, and interpersonal skills.

Responsibilities

• Conduct medical necessity reviews for Long Term Care form submissions.
• Review and analyze clinical documentation and assessments per established criteria and protocols.
• Render determinations based on Medicaid requirements and RN training, with complete documentation and rationale.
• Participate in fair hearings as assigned and prepare supporting materials.
• Review complaints and appeals, investigate facts, and recommend dispositions.
• Provide functional telephone support, operate in the phone queue, and resolve incidents, issues, requests, and queries.
• Ensure proper documentation, notification, and escalation of contacts.
• Cross-train and assist other areas as required.
• Work an 8-hour shift between 10:00 a.m. and 7:00 p.m., local time.

Skills

Communication skills

Teamwork

Leadership

Interpersonal skills

Education

RN license

High School Diploma or GED

Tools

AWS CRM

Microsoft Office

Job description

Job Title

RN (Registered Nurse)

Location

Austin, Texas (REMOTE)

Duration

Contract - 9 months

Pay Range

$35/hr - $40.74/hr on W2

Job ID

411014

About BCforward

BCforward is a leading global IT consulting and workforce solutions firm providing services and support to Fortune 500 and government clients. Founded in 1998, BCforward has grown with our customers needs into a full-service business solutions provider. With delivery centers and offices across North America and India, we take pride in building long-term relationships and delivering excellence through innovation, collaboration, and integrity.

Job Description

We are seeking a Health Clinical Services Representative (RN) to join our team. The ideal candidate will have strong experience in long-term care medical necessity reviews, Medicaid criteria, and clinical call support and a proven ability to evaluate clinical documentation, render determinations, and support providers and members by phone.

Responsibilities

• Conduct medical necessity reviews for Long Term Care form submissions.
• Review and analyze clinical documentation and assessments per established criteria and protocols.
• Render determinations based on Medicaid requirements and RN training, with complete documentation and rationale.
• Participate in fair hearings as assigned and prepare supporting materials.
• Review complaints and appeals, investigate facts, and recommend dispositions.
• Provide functional telephone support, operate in the phone queue, and resolve incidents, issues, requests, and queries.
• Ensure proper documentation, notification, and escalation of contacts.
• Cross-train and assist other areas as required.
• Work an 8-hour shift between 10:00 a.m. and 7:00 p.m., local time.

Required Skills & Qualifications

• Unrestricted Registered Nurse license.
• High School Diploma or GED.
• Demonstrated success in team-oriented environments.
• Creative and analytical problem-solving abilities.
• Desire to work in an information systems environment.
• Excellent leadership, written and oral communication, and interpersonal skills.

Preferred Skills

• Medicaid experience.
• Experience with AWS CRM and Microsoft Office.
• Effective multitasking and queue management.

Why BCforward?

• Competitive compensation and benefits.
• Opportunities for growth with global clients.
• A supportive, inclusive culture that values innovation and people.
• Exposure to cutting-edge technologies and projects.

Additional Details

• Work arrangement: Local candidates preferred. Remote eligible.
• Vaccination mandate: No.
• Travel and expenses: N/A.
• Visa restrictions: None.
• Budgeted bill rate: $55, with potential flexibility.
• Extension likelihood: High.

About Our Commitment

BCforward is an equal opportunity employer. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, or veteran status.