Remote Clinical Review Nurse — Utilization & Care Coordination

A-Line Staffing Solutions LLC; Texas; Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Benefits after 90 days

Job summary

A-Line Staffing Solutions LLC is seeking a Clinical Review Nurse to support remote members in the Central Time Zone. This role focuses on concurrent reviews, care appropriateness, and discharge planning, with collaboration across medical affairs and care management teams.

The position requires RN/LPN/LVN licensure, at least 1 year of nursing experience (2+ years acute care preferred), and a compact license. TruCare Cloud and Co-Pilot experience are a plus; remote CST hours apply.

Qualifications

• High school diploma and nursing degree; RN/LPN/LVN compact license required.
• 1+ year nursing experience; 2+ years acute care preferred.
• Bachelor's degree in nursing preferred; accredited nursing program completion

Responsibilities

• Perform concurrent reviews to determine members' health, appropriate care, and level of care.
• Review acuity, resource consumption, length of stay, quality and continuity of care, and discharge planning.
• Collaborate with Medical Affairs, Medical Directors, healthcare providers, and care management teams.
• Document concurrent review findings, discharge plans, and actions in health management systems.
• Educate providers on utilization processes and provide feedback to leadership regarding medical necessity.
• Review transfer and discharge plans to support timely transitions between levels of care and facilities.

Skills

Independent work

Teamwork

Organizational skills

Education

High school diploma

Associate degree in Nursing

Bachelor's degree in Nursing

Tools

TruCare Cloud

Co-Pilot

Job description

A-Line Staffing Solutions LLC is seeking a Clinical Review Nurse to support remote members in the Central Time Zone. This role focuses on concurrent reviews, care appropriateness, and discharge planning, with collaboration across medical affairs and care management teams.

The position requires RN/LPN/LVN licensure, at least 1 year of nursing experience (2+ years acute care preferred), and a compact license. TruCare Cloud and Co-Pilot experience are a plus; remote CST hours apply.