Job Description
Position Title: Clinical Review Nurse – Concurrent Review
Work Location: Remote – Texas
Assignment Duration: 6 months (possibility to extend or convert)
Work Schedule: Tuesday to Saturday, 8am–5pm CST (strict schedule, no flexibility)
Work Arrangement: Remote (Texas only)
Position Summary
The nurse will be reviewing about 20 cases a day to review for medical necessity on a member that admits to the hospital.
Job is to advocate and protect the member from unnecessary admissions to the hospitals.
Background & Context
High volume team environment requiring additional nurses to support weekend coverage.
Team culture is highly collaborative and supportive in high-stress situations.
Key Responsibilities
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Review approximately 20 concurrent cases daily for medical necessity.
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Complete authorizations by following frequent process and policy changes.
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Advocate for members by preventing unnecessary hospital admissions.
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Collaborate with a group of nurses to complete case reviews timely.
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Communicate with physicians and case managers to obtain clinical information and render decisions.
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Utilize multiple internal resources to complete case reviews successfully.
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Meet daily timeliness and productivity expectations.
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Communicate clearly with leadership regarding attendance or schedule issues.
Education/Certification Required: RN Preferred: BSN Licensure Required: RN Preferred: BSN Years of experience required: At least 3 years
Disqualifiers: lack of communication, flexibility, and organization skills
Additional qualities to look for:- Top 3 must-have hard skills stack-ranked by importance
1 Flexibility with constant change 2 Communication skills 3 Documentation/computer skills
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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: $ 39.00/hr.