Position Title: Clinical Review Nurse - Concurrent Review
Work Location: Remote – CST, EST (CST preferred)
Assignment Duration: 6 Months potential to extend
Work Schedule: Mon – Fri 8am – 5pm CST
OT needs approval (not required)
Possible Holiday (needs approval and not required)
Work Arrangement: Remote
Position Summary: Review clinical charts for medical necessity for inpatient admissions. Review concurrently as long as they remain in-house/inpatient until discharged.
Background & Context: Backfill for temporary worker that resigned plus 2 new positions. Business Unit: The Organization health plan.
Key Responsibilities:
• Review clinical charts for medical necessity for inpatient admissions
• Review concurrently as long as they remain in-house/inpatient until discharged
• Utilize InterQual to review medical necessities
• Make appropriate referrals for members depending on their clinical presentation
• No direct communication to members
Qualification & Experience:
| Candidate Requirements | ||||
| Education/Certification | Required: Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2-4 years of related experience | Preferred: | ||
| Licensure | Required: Registered Nurse or LPN License | Preferred: Registered Nurse License - compact | ||
| Years of experience required: Requires at least two years of Acute Care or ICU care experience. Disqualifiers: No Acute Care or ICU care experience Additional qualities to look for: adaptable, flexible, good time management skills, team player | ||||
| 1 | Minimum of 2 years of Acute or ICU clinical experience | ||
| 2 | Organizes and prioritizes effectively | |||
| 3 | Problem-solving skills | |||