Remote Clinical Review Nurse — Utilization Management

Spectraforce Technologies, Inc.; Jackson (MS); Remote; USD 65,000 - 85,000; Full time

Job summary

Spectrumforce Technologies, Inc. is seeking a Clinical Review Nurse - Concurrent Review for a 3-month contract to hire. The role is remote with work location listed as Remote-MS CST, schedule 8 am-5 pm Central time, with occasional weekend rotation.

You will perform concurrent reviews, evaluate medical necessity, and contribute to discharge planning according to care policies. The position requires an Associate degree, RN license in MS or a compact state, and at least 2 years of experience.

Qualifications

• RN licensure in MS or Compact
• 2 years of RN experience required
• Associate degree required; Bachelor preferred
• Disqualifier: LPN
• Flexible, results oriented

Responsibilities

• Performs concurrent reviews of member for appropriate care and setting
• Reviews quality and continuity of care including acuity level and discharge planning
• Collaborates with Medical Affairs/Medical Directors to discuss member care
• Documents findings and discharge plans in health management systems
• Assists providers with utilization decisions and education on processes
• Provides feedback to leadership to improve care at appropriate levels
• Reviews transfer or discharge plans to ensure timely transitions
• Collaborates with care management on member referrals
• Performs other duties as assigned
• Complies with all policies and standards

Skills

Basic Computer Knowledge

Critical Thinking Skills

Time Management/Organized

Education

Associate degree

Bachelor

Job description

Spectrumforce Technologies, Inc. is seeking a Clinical Review Nurse - Concurrent Review for a 3-month contract to hire. The role is remote with work location listed as Remote-MS CST, schedule 8 am-5 pm Central time, with occasional weekend rotation.

You will perform concurrent reviews, evaluate medical necessity, and contribute to discharge planning according to care policies. The position requires an Associate degree, RN license in MS or a compact state, and at least 2 years of experience.