Clinical Review Nurse - Concurrent Review

Location: Remote in Mississippi; candidates must reside in Mississippi

Salary: $27.02–$48.55 per hour

Company

hirify.global provides healthcare services focused on improving access to care for individuals, families, and communities.

What you will do

• Perform concurrent reviews of inpatient admissions and elective procedures to determine medical necessity, overall health, and the appropriate level and setting of care.
• Evaluate acuity, resource consumption, length of stay, continuity of care, and discharge planning.
• Document review findings, discharge plans, and actions in health management systems according to utilization management policies and guidelines.
• Collaborate with Medical Affairs, Medical Directors, care management teams, and healthcare providers on member care and medical determinations.
• Educate providers on utilization processes and provide feedback to leadership on opportunities to improve care appropriateness and medical necessity.
• Review transfer and discharge plans to support timely transitions between levels of care and facilities.

Requirements

• Residence in Mississippi is required.
• Graduation from an accredited school of nursing or a Bachelor’s degree in Nursing.
• 2–4 years of related experience, including at least 2 years of acute care experience.
• State nursing licensure is required; LPN licensure is listed for the position. RN licensure is required for Health Net of California, and RN state or compact licensure is required for Nevada.
• Clinical knowledge sufficient to assess member health, treatment needs, and the appropriate level of care.
• Knowledge of Medicare and Medicaid regulations and utilization management processes is preferred.

Culture & Benefits

• Full-time, Monday–Friday schedule.
• Health insurance and paid time off, including holidays.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Flexible work approaches, including remote, hybrid, field, and office schedules where applicable.
• Equal opportunity employment and consideration of qualified applicants regardless of legally protected characteristics.