Position Title: Clinical Review Nurse - Concurrent Review
Work Location: Remote- LA – can reside anywhere within US as long as they have a compact license
Assignment Duration: 6 Months
Work Schedule: will need to work 12-9 cst, compact license preferred. Will work tuesday-saturday, rotating holidays

Position Summary:
Position Purpose: 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.

Key Responsibilities:

• 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
• Collaborates with care management on referral of members as appropriate
• Performs other duties as assigned
• Complies with all policies and standards

Qualification & Experience:

• Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.
• 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.
• LPN - Licensed Practical Nurse - State Licensure required

Candidate Requirements
Education/Certification	Required: Registered Nurse Licensed Practical Nurse or compact license to support LA			Preferred: Registered Nurse licensure
Licensure	Required: Compact Nurse Licensure			Preferred:
Years of experience required: 1-2 years of experience   Disqualifiers: cannot work shift times or not in time zone   Additional qualities to look for: UM background – can be teachable but would be preferred Denials experience – very beneficial Medical Terminology
Top 3 must-have hard skills stack-ranked by importance		1	Multi-tasking
		2	Adapt to change well
		3	Attention to detail

 
 
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: $ 37.00/hr.