Clinical nurse h1.location_city

Clinical Review Nurse

Job Description

Join a dynamic team in a brand new 2026 program dedicated to managing the Duals line of business, combining Medicare and Medicaid benefits into a single comprehensive service. This program operates in eight states and may expand further in 2027. The role involves managing the complexities of both Medicare and Medicaid requirements simultaneously, focusing on inpatient concurrent reviews.

Responsibilities

• Conduct clincal reviews, averaging 1.85 cases per hour.
• Manage both Medicare and Medicaid requirements effectively.
• Utilize InterQual for medical management and decision-making.
• Ensure compliance with managed care policies and procedures.

Essential Skills

• Registered Nurse (RN) with a compact license.
• Experience in Utilization Management (UM).
• Proficient in concurrent review and prior authorization.
• Strong computer skills and ability to use medical management software.
• Familiarity with InterQual guidelines.
• Experience in acute care, Medicaid, and Medicare.

Work Environment

The position offers a flexible work environment where you can choose your seating location. Training lasts approximately two weeks, followed by mentorship from a preceptor. Work hours start around 8 or 9 AM, with the ability to work as late as 7 PM, and you must work within your time zone.

This is a Contract to Hire position based out of Houston, TX.

The pay range for this position is $34.00 - $40.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Mar 17, 2026.