Clinical Review Nurse - Concurrent Review

Job Title: Clinical Review Nurse - Concurrent Review - J00933 Address: Various, SC Job Description Perform concurrent reviews to assess members' overall health, medical necessity, and appropriate level and setting of care. Evaluate inpatient services, including acuity levels, resource utilization, length of stay, and discharge planning. Review clinical documentation to determine whether treatment and continued hospitalization meet established medical necessity criteria. Collaborate with Medical Affairs, Medical Directors, healthcare providers, and care management teams regarding member care. Document concurrent review findings, discharge plans, and actions taken in health management systems. Provide recommendations regarding requested services and appropriate levels of care based on clinical guidelines. Review transfer and discharge plans to support timely transitions between levels of care and facilities. ***Critical Information*** Schedule: Monday–Friday, 8:00 AM–5:00 PM EST Remote: 100% Remote Hours: Full-time, 40 hours per week Weekend Coverage: Approximately every 4–5 weekends, depending on team needs Holiday Coverage: Rotating schedule Preferred Time Zone: EST; CST candidates also considered ***Education/Licenses Needed*** Graduate of an accredited nursing program or bachelor's degree in nursing Active LPN or RN license At least 2 years of acute care nursing experience Benefits: Benefits are available to full-time employees after 90 days of employment. A 401(k) with company match is available after 1 year of service. This is an AI-formatted job description; recruiter confirmation required.