Job Description
Position Title: Clinical Review Nurse – Concurrent Review
Work Location: Remote
Assignment Duration: 12 months
Work Schedule: Monday - Friday 10:30 am CST - 7 pm CST
Position Summary:
This candidate will be working with the Tx Correspondence Team at Superior Health Plan. Tx Correspondence Team is part of Shared Services, which oversees many markets and states. The purpose of the team is to ensure that the members and requesting providers receive the written documentation of a denied service.
Background & Context:
This candidate will work with teams supporting The Organization’s markets.
Key Responsibilities:
• The purpose of the team is to ensure that the members and requesting providers receive the written documentation of a denied service.
Qualification & Experience:
• Requires graduated from an accredited school of nursing or Bachelor’s degree in nursing
• Preferred: 2-4 years of related experience
• Licensure Required: LPN or RN - Compact as long as the licensure is unrestricted we are okay
• Preferred: Compact
• Must haves: Minimum 1 year nursing experience
• Nice to haves: Knowledge of Medicare and Medicaid regulations; Knowledge of utilization management
• Disqualifiers: n/a
• Performance indicators: Metric driven in production and quality
• Top 3 must-have hard skills stack-ranked by importance:
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Ability to critically think
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Ability to effectively use Microsoft OneNote and Word
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Ability to work remotely, i.e., meet production deadlines; quality metrics
Candidate Requirements Education/Certification Required: Requires graduated from an accredited school of nursing or Bachelor’s degree in nursing Preferred: 2-4 years of related experience Licensure Required: LPN or RN - Compact as long as the licensure is unrestricted we are okay Preferred: Compact Must haves: Minimum 1 year nursing experience.
Nice to haves: Knowledge of Medicare and Medicaid regulations; Knowledge of utilization management
Disqualifiers: n/a
Performance indicators: Metric driven in production and quality- Top 3 must-have hard skills stack-ranked by importance
1 Ability to critically think 2 Ability to effectively use Microsoft OneNote and Word 3 Ability to work remotely, i.e. meet production deadlines; quality metrics
- For information on benefits, equal opportunity employment, and location-specific applicant notices, click here
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.