Clinical Review Nurse - Concurrent Review

Location: Remote in Texas; Texas RN or Compact State License required. Schedule: Monday–Friday, 8:00 AM–5:00 PM CST, plus one weekend per month.

Salary: $27.02–$48.55 per hour.

Company

hirify.global connects people with healthcare services and supports more accessible and effective care.

What you will do

• Perform concurrent reviews to assess member health, medical necessity, appropriate care settings, acuity, resource consumption, and length of stay.
• Review inpatient services and transfer or discharge plans to support timely transitions between levels of care and facilities.
• Document review findings, discharge plans, medical determinations, and actions in health management systems.
• Collaborate with Medical Affairs, Medical Directors, care management teams, and healthcare providers on member care and referrals.
• Approve requested services or provide recommendations based on clinical policies, utilization management guidelines, and review findings.
• Educate providers and share improvement opportunities with leadership regarding appropriate levels of care and medical necessity.

Requirements

• Texas RN license or Compact State License required.
• Graduation from an accredited nursing school or a Bachelor’s degree in Nursing.
• Two or more years of acute care experience and 2–4 years of related experience.
• LPN state licensure or RN state and/or compact state licensure.
• Availability for the stated CST schedule and one weekend per month.
• Knowledge of clinical assessment, appropriate levels of care, utilization management, and healthcare regulations.

Nice to have

• ICU or emergency room experience.
• Knowledge of Medicare and Medicaid regulations.
• Experience determining treatment needs and appropriate levels of care.

Culture & Benefits

• Health insurance and paid time off plus holidays.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Flexible work approaches, including remote, hybrid, field, and office schedules.
• Equal opportunity workplace committed to diversity and inclusion.