Utilization Review Nurse

IMCS Group; United States; Remote; USD 48.216 - 59.236; Vollzeit

Zusammenfassung

A healthcare organization is seeking a Clinical Review Nurse – Concurrent Review to perform utilization management functions remotely. The role requires conducting concurrent reviews, collaborating with medical teams, and ensuring quality healthcare outcomes. Candidates should have an ADN or BSN and 2–4 years of experience, particularly in concurrent review and InterQual. Strong communication, attention to detail, and proficiency in Microsoft Office tools are essential. This position offers the opportunity to be part of a supportive and collaborative team.

Qualifikationen

• 2–4 years of related experience, including concurrent review and InterQual.
• Preferred TruCare experience.
• Proficiency in InterQual and Microsoft Office tools.

Aufgaben

• Conduct concurrent reviews of member care and discharge plans.
• Collaborate with providers and medical directors for appropriate care.
• Provide subject matter expertise to utilization management teams.

Kenntnisse

Strong communication

Detail-oriented

Tech-savvy

Ausbildung

ADN or BSN; Graduate from an accredited school of nursing

Tools

InterQual

Microsoft OneNote

Microsoft Word

Microsoft Excel

Microsoft Teams

Jobbeschreibung

Base pay range

$35.00/hr - $43.00/hr

Job Title

Clinical Review Nurse – Concurrent Review

Location: Remote (California only – must reside in CA or hold an active CA RN license)

Duration: 12 months (with potential to extend or convert)

Schedule: Training 8 AM – 5 PM PST (approx. 4 weeks, cameras on, no time off). Regular work schedule 8 AM – 5 PM PST.

About the Role

The Clinical Review Nurse – Concurrent Review will perform utilization management functions to ensure members receive the right care at the right time. This role focuses on discharge planning, concurrent reviews, and medical necessity determinations in alignment with InterQual and organizational guidelines.

Responsibilities

• Conduct concurrent reviews of member care, length of stay, acuity, and discharge plans.
• Review member transfers or discharges to ensure timely coordination between care levels and facilities.
• Collaborate with providers, care management, and medical directors to ensure appropriate and cost-effective care.
• Complete 17–20 reviews per day while maintaining high-quality standards.
• Manage and document concurrent review findings, discharge plans, and medical determinations in health management systems.
• Educate providers on utilization processes to promote quality, appropriate care.
• Support interdepartmental projects and report trends, offering recommendations for process improvement.
• Provide subject matter expertise and guidance to utilization management teams.

Candidate Requirements

• Education: ADN or BSN; Graduate from an accredited school of nursing.
• Experience: 2–4 years of related experience, including concurrent review and InterQual.
• Preferred: TruCare experience.
• Technical Skills: Proficiency in InterQual, Microsoft OneNote, Word, Excel, and Teams.
• Soft Skills: Strong communication, ability to thrive in a fast-paced environment, detail-oriented, and tech-savvy.
• Time-off requests during the first 90 days of employment.

What Makes This Role Unique

• You’ll be part of a supportive, collaborative team.
• Every review helps ensure quality healthcare outcomes while supporting cost-effective delivery.
• Leadership emphasizes clarity, accountability, and growth with clear expectations and feedback.