Clinical Review Nurse - Concurrent Review

Location: Remote in California; Monday-Friday, 8:00 am-5:00 pm Pacific Standard Time, with regular weekend and holiday rotation.

Salary: $27.02-$48.55 per hour.

Company

hirify.global connects people with healthcare services and supports individuals, families, and communities through health insurance and care management.

What you will do

• Perform concurrent reviews to assess members’ overall health, medical necessity, appropriate level of care, and care setting.
• Review acuity, resource consumption, length of stay, care quality, continuity of care, and discharge plans.
• Collaborate with Medical Affairs, medical directors, care management teams, and healthcare providers on member care and referrals.
• Document review findings, medical records, discharge plans, and actions in health management systems.
• Approve medical determinations or provide recommendations based on requested services and review findings.
• Educate providers on utilization processes and identify opportunities to improve medically appropriate care.

Requirements

• Active California RN license required.
• 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.
• Clinical knowledge of treatment needs, overall health assessment, and appropriate levels of care.
• Ability to work the required Pacific Time schedule and participate in weekend and holiday rotations.

Nice to have

• Knowledge of Medicare and Medicaid regulations.
• Knowledge of utilization management processes.

Culture & Benefits

• Health insurance and comprehensive benefits package.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Paid time off and holidays.
• Remote, hybrid, field, and office work approaches are supported across the organization.