Remote Clinical Review Nurse - Concurrent Review

Spectraforce Technologies; Raleigh (NC); On-site; USD 60,000 - 90,000; Full time

Job summary

Spectraforce Technologies is seeking a Clinical Review Nurse for concurrent review. This remote role supports US-based operations, requiring a nursing credential and at least 1 year of nursing experience.

The position emphasizes denial review, NCQA standards, and coordinated communication with agencies and teams. The candidate will draft letters, investigate denials, and help train teams to improve utilization management processes.

Qualifications

• Graduated from an accredited nursing program (ADN/BSN)
• Preferred: 2–4 years of related experience
• RN or LPN, active in any state
• Minimum 1 year nursing experience; live anywhere in the U.S.
• Knowledge of Medicare/Medicaid regulations; knowledge of utilization management

Responsibilities

• Drafts correspondence letters based on review outcomes per NCQA standards
• Works with senior management to identify and implement improvement opportunities
• Investigates denials through review of clinical documentation and guidelines
• Assists with issues related to correspondence with state, local, and federal agencies
• Maintains and monitors cases to ensure timely resolution and documentation
• Coordinates with interdepartmental teams on training needs in utilization management
• Provides feedback to leadership to improve processes and prevent recurrences
• Performs other duties as assigned and complies with policies

Skills

Critical thinking

Remote work

Meeting deadlines

Education

Nursing degree (RN/LPN)

Tools

Microsoft OneNote

Microsoft Word

Job description

Spectraforce Technologies is seeking a Clinical Review Nurse for concurrent review. This remote role supports US-based operations, requiring a nursing credential and at least 1 year of nursing experience.

The position emphasizes denial review, NCQA standards, and coordinated communication with agencies and teams. The candidate will draft letters, investigate denials, and help train teams to improve utilization management processes.