Clinical Review Nurse - Concurrent Review

Clinical Review Nurse - Concurrent ReviewImmediate need for a talented Clinical Review Nurse - Concurrent Review. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote).Key Responsibilities:Conduct concurrent reviews to determine medical necessity and appropriateness of careAssist in evaluating inpatient services and contribute to discharge planningPrepare denial letters for FL Medicaid Physical Health CodesMeet production metrics of 95%-105% after the training periodCollaborate with healthcare teams to ensure compliance with care policiesKey Requirements and Technology Experience:1+ years of experience in clinical review or a related fieldRN Compact LicenseKnowledge of Medicare and Medicaid regulations is preferredFamiliarity with utilization management processes is a plusExperience with MCO, specifically with Medicaid, is a bonusProficiency in True Care Cloud is advantageousAbility to work possible weekend hours and holidays on a rotation basis