Clinical Review Nurse - Concurrent Review

Job DescriptionJob DescriptionTitle: Clinical Review Nurse - Concurrent ReviewLocation: Remote - KentuckyPay: $40–$43 per hour, based on experienceSchedule Options: Monday–Friday, 8:00 AM–5:00 PM EST, with rotating weekend coverage (one weekend every 5–6 weeks, Saturday and Sunday), OR Tuesday–Saturday, 8:00 AM–5:00 PM EST, with an option to work four 10-hour shiftsEmployment Type: 6-Month W2 Temp-to-hire Assignment with potential for extension or conversion to FTE based on business needsPosition DescriptionWe are seeking an experienced Clinical Review Nurse to support concurrent utilization management reviews for inpatient medical stays under Kentucky Medicaid. This role will also support Marketplace and Medicaid business lines to help manage review volume. The nurse will evaluate inpatient cases, review clinical documentation, and help determine whether medical services meet established criteria for coverage and medical necessity.ResponsibilitiesConduct concurrent utilization reviews for Kentucky Medicaid inpatient medical stays.Review medical records and clinical documentation to assess medical necessity and appropriateness of care.Apply utilization management guidelines and established review criteria when evaluating cases.Complete approximately 19–21 reviews per day while maintaining accurate documentation.Support review volume across Medicaid and Marketplace lines of business.Collaborate with the clinical review team to manage daily workloads and review needs.RequirementsActive Registered Nurse (RN) or Licensed Practical Nurse (LPN) license; compact license preferred.Graduate of an accredited nursing program or a bachelor's degree.2–4 years of related professional experience.Previous utilization management (UM) experience is required.Relevant clinical review experience, preferably involving inpatient concurrent reviews.Ability to review clinical documentation, apply medical necessity criteria, and manage daily review expectations.