Clinical Review Nurse - Concurrent Review

Location: Remote from Arizona; supports members in Arizona, Nevada, Oregon, and Washington. Monday–Friday, 8:00 a.m.–5:00 p.m. in the resident’s time zone, with rotational weekends and holidays.

Salary: $27.02–$48.55 per hour

Company

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

What you will do

• Perform concurrent reviews to assess members’ health, medical necessity, acuity, resource use, length of stay, and appropriate care settings.
• Review and document clinical findings, discharge plans, care actions, and medical records in health management systems.
• Collaborate with Medical Affairs, Medical Directors, care management teams, and healthcare providers on care determinations and referrals.
• Review transfer and discharge plans to support timely transitions between facilities and levels of care.
• Educate providers on utilization management processes and provide leadership feedback on opportunities to improve care appropriateness.

Requirements

• Graduate of an accredited school of nursing or bachelor’s degree in nursing.
• 2–4 years of related experience, including at least 2 years of acute care experience.
• Required nursing licensure: LPN state licensure; RN state licensure and/or compact-state licensure for Nevada.
• Ability to assess members’ overall health, treatment needs, and appropriate levels of care.
• Knowledge of Medicare and Medicaid regulations and utilization management processes is preferred.

Nice to have

• Acute rehabilitation, skilled nursing facility, or long-term care experience.
• RN compact nursing licensure or the ability to obtain additional state licenses as needed.

Culture & Benefits

• Remote work-from-home arrangement with a flexible approach to work schedules.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Licensure costs for additional required states are reimbursed by the company.
• Commitment to equal employment opportunity and workplace diversity.