Position Title: Clinical Review Nurse Concurrent Review
Location: Fully Remote (Texas)
Duration: 6 Months | Possible Extension
Schedule: 10am-7pm CST, Schedule can be Sun-Thurs or Tues-Sat
Pay rate: $38.00-43.00/hr
Daily Schedule & OT Expectations:
Review approximately 20 hospital admission cases daily for medical necessity.
Advocate and protect members from unnecessary hospital admissions.
Follow frequent process updates and authorization guidelines.
Collaborate with a team of nurses to support case completion.
Communicate regularly with doctors and case managers to clarify member condition and status.
Utilize multiple internal resources to complete case reviews successfully.
Typical Task Breakdown & Rhythm
Case review and medical necessity evaluation (~20 cases/day).
Coordinating with healthcare providers and case managers.
Applying updated clinical guidelines and authorization protocols.
Documenting case findings and authorization decisions.
Participating in team discussions and weekly huddles.
Interaction Level with Team
High collaboration within a close-knit nursing team.
Regular communication via virtual platforms due to remote work setup.
Open, supportive environment encouraging teamwork and knowledge sharing.
Work Environment Description
Remote work-from-home role with virtual team engagement.
Emphasis on teamwork despite physical distance through weekly social huddles.
Supportive culture focused on collaboration and mutual assistance.
Education:
Registered Nurse (RN) license
Licensure:
RN license (TX RN license or compact state license preferred)
Experience:
Must have 2 4 years of hospital experience.
Experience in multitasking, time management, and adaptability is critical.
Preferred experience in Utilization Management (UM) or clinical/managed care is a plus.
Top 3 Must-Have Hard Skills (Stack-ranked)
TX RN license or compact state license
Strong communication skills (verbal and written)
Proficient documentation and computer skills
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