Position Title: Clinical Review Nurse - Concurrent Review

Work Location: Remote, Ohio, have to have Ohio RN license

Assignment Duration: 6 months

Position Summary:

• The purpose of this team is to review inpatient hospital requests for inpatient level of care.

• We work in coordination with care management on discharge planning.

• We are placing this request for staff for a nurse who is on leave.

• This is a temp to a possible perm position.

• We have a three-day turn-round time for our determinations; we need an extra staff member to assist to make sure we meet our requirements.

• Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care

• Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member

• Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered

• Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines

• Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings

• Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members

• Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines

• Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities

Qualification & Experience:

• Education/Certification Required: Associates

• Preferred: Bachelors

• Licensure Required: Ohio LPN

• Preferred: RN

• Must haves: Inpatient hospital experience, preferably UM review experience. Computer skills.

• Nice to haves: Experience in Microsoft teams, outlook, and excel.

• Disqualifiers:

• Performance indicators: 1.2 reviews per hour minimum.

• Top 3 must-have hard skills

  • Inpatient Hospital experience

  • UM Concurrent Review

  • Ability to work in a remote environment

    Candidate Requirements
    Education/Certification	Required: Associates			Preferred: Bachelors
    Licensure	Required: Ohio LPN			Preferred: RN
    Years of experience required Disqualifiers Best vs. average Performance indicators		Must haves: Inpatient hospital experience, preferably UM review experience. Computer skills.   Nice to haves: Experience in Microsoft teams, outlook, and excel.   Disqualifiers:   Performance indicators: 1.2 reviews per hour minimum.
    Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection		1	Inpatient Hospital experience
    		2	UM Concurrent Review
    		3	Ability to work in a remote environment

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 40.00/hr.