Remote Concurrent Review Nurse - Utilization & Care

Axelon Services Corporation; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

Axelon Services Corporation is seeking a Nursing professional for a 6-month remote role focused on concurrent reviews and utilization management. The candidate will assess member health, determine appropriate care levels, and collaborate with Medical Affairs to support quality of care.

The position requires an RN or LPN license, a nursing degree, and at least 2 years of related and acute care experience. Candidates should be familiar with Medicare/Medicaid regulations and be prepared for

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing.
• Minimum 2 years of related experience.
• 2 years of acute care experience required.
• Clinical knowledge to determine overall member health and need for care.
• Knowledge of Medicare/Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.
• LPN license required.
• RN license required for Health Net of California.
• RN license and/or compact license for Nevada required.

Responsibilities

• Perform concurrent reviews of members to determine appropriate care level.
• Review quality and continuity of care by assessing acuity, resource use, LOS, and discharge planning.
• Collaborate with Medical Affairs/Medical Directors as needed.
• Document findings and discharge plans in health management systems per policies.
• Work with healthcare providers to approve determinations or provide recommendations.
• Educate providers on utilization processes to ensure high‑quality care.
• Provide feedback to leadership on opportunities to improve care levels and medical necessity.
• Review transfer or discharge plans for timely escalation between levels of care.
• Collaborate with care management on referrals.
• Perform other duties as assigned and comply with policies.

Education

Bachelor's degree in Nursing

Job description

Axelon Services Corporation is seeking a Nursing professional for a 6-month remote role focused on concurrent reviews and utilization management. The candidate will assess member health, determine appropriate care levels, and collaborate with Medical Affairs to support quality of care.

The position requires an RN or LPN license, a nursing degree, and at least 2 years of related and acute care experience. Candidates should be familiar with Medicare/Medicaid regulations and be prepared for