Clinical Review Nurse - Concurrent Review

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)

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.

High volume team environment requiring additional nurses to support weekend coverage.

Team culture is highly collaborative and supportive in high-stress situations.

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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