Clinical Review Nurse - Concurrent Review

Job Title

Summary:

Work Mode: 100% Remote - MS (candidates can be outside Mississippi but MUST have compact license & willing to work CST hours)

Duration: 3 months, possible extension

Shift: 8am-5pm (Central) OT is voluntary; weekend rotation once in every 2 months/fully staffed

Responsibilities:

Perform medical necessity reviews of inpatient admissions and continued stays.

Apply clinical criteria and guidelines such as InterQual, internal clinical policies, and plan-specific requirements.

Communicate with hospitals and review clinical documentation.

Make authorization determinations within nursing scope.

Identify discharge planning needs and barriers.

Collaborate with case management and other staff.

Process 2.2 reviews per hour (14-16 reviews daily).

Coordinate post-acute services and ensure appropriate utilization, regulatory compliance, safe transitions of care, reduced length of stay, and prevention of avoidable readmissions.

Requirements:

Required Education: Associate degree

Required Licensure: Registered Nurse License (MS or Compact)

Minimum 2 years of experience

Disqualifiers: Not a RN, No compact License if outside MS

Preferred Skills:

Preferred Education: Bachelor

Preferred Licensure: RN License

Basic Computer Knowledge

Critical Thinking Skills

Time Management/Organized

Flexible and Results oriented