Position Title: Clinical Review Nurse – Concurrent Review
Work Location: Remote
Assignment Duration: 6 months with possibility of extension
Work Schedule: 12-9 CST Sun-Thurs  

Position Summary:
Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines.
Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Specific to the denial letters. No member or provider outreach

Key Responsibilities:
Denial Letters for Concurrent Review
Daily Points are the measurement
Will work within TruCare Classic, excel, outlook, word, one note.

Qualification & Experience:
• Required: RN - Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and
• Required: Compact license is REQUIRED – working multiple states
• Years of experience required: 2 – 4 years of related experience. 2+ years of acute care experience required.
• Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred.
• Knowledge of Medicare and Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.
• Disqualifiers: LPN, most recent position must be related field, ****Please ensure candidates are literate in written and spoken English
• Additional qualities to look for: Self-starter

Candidate Requirements
Education/Certification	Required: RN - Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and			Preferred:
Licensure	Required: Compact license is REQUIRED – working multiple states			Preferred:
Years of experience required: 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred.   Disqualifiers: LPN, most recent position must be related field, ****Please ensure candidates are literate in written and spoken English   Additional qualities to look for: Self-starter
Top 3 must-have hard skills stack-ranked by importance		1	Self-Starter/independent worker
		2	Time Management/attention to detail/accuracy
		3	Flexibility - willing to jump around with volume shifts in specific areas

 

 
 
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.