Position Title: Clinical Review Nurse - Concurrent Review 
Work Location:  Remote, Compact Nursing License Required, Central Time Zone
Assignment Duration: 12 Months possibility of extension or conversion
Work Schedule: Friday-Tues, 2 pm-10 pm CST, 40 hours/week.
So, either five 8-hour shifts until 10 PM EST, Friday-Tues, OR four 10-hour shifts until 10 pm EST, Sat-Tues
Occasional overtime may be requested based on workload or regulatory deadlines.
Potential holiday workdays

Job Description:

Job Profile 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.

Education/Experience:
Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 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.
Typing assessment for accuracy

License/Certification:
LPN - Licensed Practical Nurse - State Licensure required
For Health Net of California: RN license required
 

Candidate Requirements
Education/Certification	Required: Required: Highschool Diploma, Nursing Degree- Associates or Above			Preferred:
Licensure	Required: Compact Nursing License-RN, LPN, LVN.			Preferred:
Years of experience required: 1+ years,   Disqualifiers: Inability to work possible weekend hours and holidays on a rotation basis as applicable or needed by business needs   Additional qualities to look for: MCO experience, specifically with Medicaid, True Care Cloud experience is a bonus, experience working remote
Top 3 must-have hard skills stack-ranked by importance		1	Ability to complete work independently and with minimal supervision after training.
		2	Team player
		3	Great organizational skills

  
 
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 pay range is $38.00/hr - $40.00/hr.