Clinical Review Nurse - Concurrent Review

Compact Nursing PositionLocation: 100% Remote, Central Time Zone SHIFT: Friday-Tues, 2 pm-10 pm CST, 40 hours/week. So, either five 8-hour shifts until 10 PM EST, Friday-Tues, OR four 10-hour shifts until 10 pm EST, Sat-Tues Duration: Coverage for FTE on LOAJob Profile Summary: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.Position Purpose: Denial Letters for FL Medicaid Physical Health Codes Daily Points are the measurement of production Must meet 95%-105% production after training period Remote Work, Will work within TruCare ClassicCandidate RequirementsEducation/Certification - Required: Highschool Diploma, Nursing Degree- Associates or Above - Preferred:Licensure - Required: Compact Nursing License-RN, LPN, LVN. - Preferred:Years of experience required: 1+ years, Disqualifiers: Inability to work possible weekend hours and holidays on a rotation basis as applicable or needed by business needsAdditional qualities to look for: MCO experience, specifically with Medicaid, True Care Cloud experience is a bonus, experience working remoteTop 3 must-have hard skills stack-ranked by importance - 1 - Ability to complete work independently and with minimal supervision after training.2 - Team player3 - Great organizational skills