Clinical Review Nurse - Concurrent Review

Location: Remote in Illinois; Monday-Friday, 8am-5pm Central Time, with rotating weekends and holidays

Salary: $27.02-$48.55 per hour

Company

hirify.global connects people with healthcare services and supports Medicaid, Medicare, and other health coverage programs.

What you will do

• Perform concurrent reviews to assess members’ overall health, medical necessity, appropriate care settings, and levels of care.
• Review acuity, resource utilization, length of stay, quality and continuity of care, and discharge plans.
• 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.
• Approve requested services or provide recommendations based on clinical policies, guidelines, and review findings.
• Educate providers and provide leadership feedback on utilization processes and opportunities to improve medical necessity and care levels.

Requirements

• Graduate from an accredited school of nursing or hold a bachelor’s degree in nursing.
• 2-4 years of related experience, including at least 2 years of acute care experience.
• Illinois RN state licensure is required; LPN state licensure is also listed as required.
• Clinical knowledge sufficient to assess overall health, treatment needs, and appropriate levels of care.
• Knowledge of Medicare and Medicaid regulations and utilization management processes is preferred.

Culture & Benefits

• Remote work-from-home schedule with rotating weekend and holiday coverage.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Compensation is adjusted based on skills, experience, education, job-related factors, and employment status.
• Additional incentive compensation may be available subject to program eligibility.