Clinical Review Nurse - Concurrent Review

Position Title: Clinical Review Nurse-Concurrent ReviewWork Location: Remote (West Coast sourcing only)Assignment Duration: 02+ MonthsWork Schedule:Training 8AM-5PM CST Mon-Fri (2 weeks, NO TIME OFF)10-7 CST Monday-FridayHoliday's as needed with noticeWork Arrangement: Remote to West Coast (national sourcing but only West Coast)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. Specific to the denial letters. No member or provider outreachBackground & Context:TLAR ReductionKey Responsibilities:Denial Letters for Concurrent ReviewDaily Points are the measurementWill work within TruCare Classic, excel, outlook, word, one note.Qualification & Experience:Education/Certification Required: RN - Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and Preferred:Licensure Required: TX or compact license Preferred:Years of experience required: 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.Disqualifiers: LPN, most recent position must be related fieldAdditional qualities to look for: Self-starterTop 3 must-have hard skills stack-ranked by importance1 Self-Starter/independent worker2 Time Management/attention to detail/accuracy3 Flexibility - willing to jump around with volume shifts in specific areasSPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at if you require reasonable accommodation.

Created: 2025-09-12