Clinical Review Nurse - Concurrent Review

Location: Remote in New Jersey; must reside in the EST or CST time zones

Salary: $27.02–$48.55 per hour

Company

hirify.global connects people with healthcare services and works to improve access and health outcomes for individuals, families, and communities.

What you will do

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

Requirements

• Must reside in the EST or CST time zones.
• 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.
• State licensure as an LPN is required.
• Clinical knowledge sufficient to assess members’ health, treatment needs, and appropriate levels of care.
• Knowledge of Medicare and Medicaid regulations and utilization management processes is preferred.

Culture & Benefits

• Full-time employment with a flexible approach to remote, hybrid, field, or office work schedules.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Compensation may vary based on skills, experience, education, and other job-related factors.
• Equal opportunity workplace committed to diversity and inclusion.