Remote Clinical Review Nurse – Utilization Management

Spectraforce Technologies, Inc.; Raleigh (NC); Remote; USD 55,000 - 77,000; Full time

Job summary

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Concurrent Review for a remote role with EST preference. The position involves assessing patient health, determining medical necessity, and contributing to discharge planning under care policies.

Requires an accredited nursing degree (RN or BSN), RN or LPN licensure, and 2–4 years of acute care or UM experience. NVIDIA, remote work, and rotated holiday coverage may apply.

Qualifications

• Accredited School of Nursing or bachelor’s degree in nursing.
• 2–4 years of related experience in nursing, UM or managed care preferred.
• RN or LPN licensure required; active licensure.

Responsibilities

• Performs concurrent reviews to determine appropriate care and level of care.
• Reviews quality and continuity of care including discharge planning.
• Collaborates with Medical Affairs/Directors as needed.
• Documents findings and actions in health management systems per policies.
• Interacts with healthcare providers to approve determinations or provide recommendations.
• Educates providers on utilization processes to ensure high‑quality care.
• Provides feedback to leadership on opportunities to improve care and NM.
• Reviews transfer or discharge plans to ensure timely transitions.
• Collaborates with care management on referrals as appropriate.
• Performs other duties as assigned and complies with policies.

Skills

Clinical knowledge

Medicare/Medicaid regulations

Utilization management

Education

Nursing degree (RN or BSN)

Job description

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Concurrent Review for a remote role with EST preference. The position involves assessing patient health, determining medical necessity, and contributing to discharge planning under care policies.

Requires an accredited nursing degree (RN or BSN), RN or LPN licensure, and 2–4 years of acute care or UM experience. NVIDIA, remote work, and rotated holiday coverage may apply.