Position Title: Clinical Review Nurse – Concurrent Review
Work Location: Remote – Texas (CST)
Assignment Duration: 6 Months (Contract to Hire)
Work Schedule: Tuesday – Saturday, 8am–5pm CST (Training Mon–Fri 8–5)
Work Arrangement: Remote

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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.

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Background & Context

Fast-paced clinical review team supporting medical necessity determinations. Nurse reviews faxed clinical documentation from facilities and works from task queues to meet daily deadlines.

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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

• Collects, documents, and maintains concurrent review findings

• Works with healthcare providers to approve medical determinations

• Provides education to providers on utilization processes

• Provides feedback to leadership on care improvement opportunities

• Reviews transfer or discharge plans

• Collaborates with care management

• Performs other duties as assigned

• Complies with all policies and standards

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Qualification & Experience

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing

• 2–4 years related experience (4 preferred)

• 2+ years acute care experience required

• Clinical knowledge to determine treatment needs and level of care

• Knowledge of Medicare/Medicaid preferred

• Knowledge of utilization management preferred

 
 
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: $ 38.00/hr.