Clinical Review Nurse - Concurrent Review

Title: Clinical Review Nurse - Concurrent Review
Location: Remote
Duration: 06 Months - Possible extension
Mon - Fri | 8am - 5pm CST
OT needs approval (not required) | Possible Holiday (needs approval and not required)

Responsibilities:

• Review clinical charts for medical necessity for inpatient admissions
• Review concurrently as long as they remain in-house/inpatient until discharged
• Utilize InterQual to review medical necessities
• Make appropriate referrals for members depending on their clinical presentation
• No direct communication to members

Candidate Requirements Education/Certification Required: Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2-4 years of related experience Preferred: Licensure Required: Registered Nurse or LPN License Preferred: Registered Nurse License - compact Years of experience required: Requires at least two years of Acute Care or ICU care experience.

Disqualifiers: No Acute Care or ICU care experience

Additional qualities to look for: adaptable, flexible, good time management skills, team player

• Top 3 must-have hard skills stack-ranked by importance

1 Minimum of 2 years of Acute or ICU clinical experience 2 Organizes and prioritizes effectively 3 Problem-solving skills