Clinical - Clinical Review Nurse - Concurrent Review - J00933

Job Title: Concurrent Review Nurse

Location: Remote Mississippi / Compact License

Duration: 3 months

Schedule: 8am-5pm (CST) OT is voluntary; weekend rotation once in every 2mos/fully staffed

XXXX: XXXXXXXXXXX/hr. on w2

Position Purpose:

The Concurrent Review Nurse performs inpatient concurrent reviews to determine medical necessity, appropriate level of care, and continued stay requirements. The role includes reviewing clinical documentation, assessing member health status, supporting discharge planning, and collaborating with providers, Medical Directors, and Care Management.

Key Responsibilities:

• Perform concurrent reviews of inpatient members to determine appropriate care and level of service.
• Conduct medical necessity and continued stay reviews using InterQual, internal clinical policies, and plan-specific guidelines.
• Review acuity, resource utilization, length of stay, and discharge planning needs.
• Review clinical documentation and maintain accurate concurrent review findings in health management systems.
• Identify discharge barriers and support timely transitions between levels of care and facilities.
• Collaborate with hospitals, healthcare providers, Medical Directors, Care Management, and Medical Affairs.
• Make authorization determinations within nursing scope and provide recommendations based on clinical review findings.
• Educate providers regarding utilization management processes when needed.
• Identify opportunities to improve appropriate level of care and medical necessity.
• Process approximately 2.2 reviews per hour / 14 16 reviews daily.
• Comply with all applicable policies, clinical guidelines, and standards.

Required Qualifications

• Associate degree required; Bachelor's degree preferred.
• Active Registered Nurse (RN) license Mississippi or Compact required.
• Minimum 2 years of nursing experience.
• Minimum 2 years of acute care experience required.
• Strong clinical assessment and critical-thinking skills.
• Knowledge of utilization management processes preferred.
• Knowledge of Medicare and Medicaid regulations preferred.
• Basic computer proficiency.
• Strong time-management and organizational skills.
• Flexible and results-oriented.

Disqualifier: LPN candidates.

Top 3 must-have hard skills stack-ranked by importance:

1. Basic Computer Knowledge
2. Critical Thinking Skills
3. Time Management/Organized