Clinical - Clinical Review Nurse - Concurrent Review

Job Description :

Job Title : Clinical Review Nurse Concurrent Review

Location : Remote

Duration : 6 months (Possible Extension)

Schedule : Sunday to Thursday 8am to 5pm CST

Position Overview

We are seeking a Concurrent Review Nurse (RN) to join our Utilization Management team supporting Health Plan (Medicaid). This role is responsible for conducting clinical reviews to ensure that inpatient stays meet medical necessity criteria and that appropriate levels of care are maintained. The position plays a critical part in coordinating care between providers, case managers, and internal teams to ensure timely and high-quality outcomes for members.

This is a fully remote position, offering flexibility, professional growth, and the opportunity to make a direct impact on patient care quality and compliance.

Key Responsibilities

Conduct clinical reviews of inpatient hospital stays to determine medical necessity and continued stay criteria.

Document all reviews, findings, and determinations accurately and within established timelines.

Collaborate with hospital case managers, providers, and internal departments to coordinate care and discharge planning.

Respond to escalations or requests for additional information from utilization management or quality teams.

Prioritize and manage case workload to maintain compliance with turnaround and quality standards.

Support workflow continuity and compliance during staff transitions and high-volume periods.

Education & Licensure

Required : Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN).

Required : Active Registered Nurse (RN) license in good standing in the state of residence.

Qualifications & Experience

3 5 years of acute clinical experience in settings such as ER, ICU, IMC, or similar.

Strong critical thinking, organizational, and prioritization skills.

Technologically proficient, with experience using EMR systems and multiple platforms simultaneously.

Strong written and verbal communication skills.

Preferred : Prior experience in Concurrent Review, Utilization Review, or Managed Care.

Why Join This Team

Be part of a collaborative, respectful, and flexible team culture.

Work fully remote, with an emphasis on balance and authenticity.

Gain exposure to clinical review operations, cross-functional collaboration, and Medicaid processes.

Opportunity for extension or conversion based on performance.