Remote Clinical Review Nurse - Concurrent Care & Discharge

Spectraforce Technologies, Inc.; Houston (TX); Remote; USD 65,000 - 90,000; Full time

Job summary

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse for remote work with a Central Time Zone schedule. The role involves concurrent reviews, determining level of care, and contributing to discharge planning.

Qualifications include a nursing degree (AS or higher) and compact nursing licensure (RN/LPN/LVN). Requires 1+ years of experience and comfort working remotely with weekend/holiday rotation as needed.

Qualifications

• Education: High school diploma or nursing degree (AS or higher).
• Licensure: Compact Nursing License (RN, LPN, LVN).
• Experience: 1+ years in a clinical review/acute care setting.

Responsibilities

• Perform concurrent reviews to determine appropriate level of care and care settings.
• Assess medical necessity and contribute to discharge planning.
• Collaborate with Medical Affairs/Medical Directors as needed.
• Document findings in health management systems per utilization management policies.
• Coordinate with providers to discuss determinations and recommendations.
• Educate providers on utilization processes to ensure appropriate care.
• Provide feedback to leadership on opportunities to improve care and medical necessity.
• Review transfer or discharge plans to ensure timely transitions.
• Collaborate with care management on referrals as appropriate.
• Perform other duties as assigned.

Skills

Independent work

Team player

Organizational skills

Education

Nursing degree (AS or higher)

High school diploma

Job description

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse for remote work with a Central Time Zone schedule. The role involves concurrent reviews, determining level of care, and contributing to discharge planning.

Qualifications include a nursing degree (AS or higher) and compact nursing licensure (RN/LPN/LVN). Requires 1+ years of experience and comfort working remotely with weekend/holiday rotation as needed.