Clinical Review Nurse - Concurrent Review

Location: Remote in Missouri

Salary: $27.02–$48.55 per hour

Company

hirify.global connects people with healthcare services and works to make care more accessible and effective.

What you will do

• Perform concurrent reviews to assess members’ health, medical necessity, appropriate care settings, acuity, resource consumption, and length of stay.
• Review transfer and discharge plans to support timely transitions between levels of care and facilities.
• Work with Medical Affairs, medical directors, healthcare providers, and care management teams on clinical determinations and referrals.
• Document review findings, discharge plans, and actions in health management systems according to utilization management policies.
• Provide education to providers on utilization processes and recommendations based on review findings.
• Share opportunities to improve appropriate care levels and medical necessity with leadership.

Requirements

• Active, unrestricted Compact RN License or applicable state/compact licensure required.
• Graduate from an accredited school of nursing or hold a Bachelor’s degree in Nursing.
• At least 2 years of acute care nursing experience required.
• Two to four years of related experience.
• Knowledge of clinical assessment, treatment needs, and appropriate levels of care.
• Knowledge of Medicare and Medicaid regulations and utilization management processes is preferred.

Nice to have

• Previous utilization management, utilization review, case management, or care management experience.
• Residence in Missouri.

Culture & Benefits

• Remote work arrangement with a flexible approach to remote, hybrid, field, or office schedules.
• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Compensation may vary based on skills, experience, education, job-related factors, and employment status.