Clinical Review Nurse - Concurrent Review

Summary:

• Location: 100% Remote, Compact Nursing License Required, Central Time Zone
• Work Mode: Remote
• Duration: Coverage for FTE on LOA
• SHIFT: Friday-Tues, 2 pm-10 pm CST, 40 hours/week. Either five 8-hour shifts until 10 PM EST, Friday-Tues, or four 10-hour shifts until 10 pm EST, Sat-Tues

Responsibilities:

• Perform 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.
• Assist in evaluating inpatient services to validate the necessity and setting of care being delivered to the member.
• Handle denial letters for FL Medicaid Physical Health Codes.
• Meet daily points as a measurement of production, achieving 95%-105% production after the training period.

Requirements:

• Education: Highschool Diploma, Nursing Degree- Associates or Above
• Licensure: Compact Nursing License-RN, LPN, LVN
• Minimum 1 year of experience required.
• Ability to work possible weekend hours and holidays on a rotation basis as applicable or needed by business needs.

Preferred Skills:

• MCO experience, specifically with Medicaid.
• True Care Cloud experience is a bonus.
• Experience working remotely.
• Ability to complete work independently and with minimal supervision after training.
• Team player.
• Great organizational skills.