Clinical Review Nurse - Concurrent Review

Position Title: Clinical Review Nurse - Concurrent Review
Work Location: Remote - Any US State
Assignment Duration: 12 months
Work Arrangement: Fri-Sat-Sun-Mon 8:30 am CST - 6 pm CST

Responsibilities:
Working within a highly engaged team remotely, with ongoing support to produce denial correspondence based off the advisor review that is in easy-to-understand language to the member and adheres to the NCQA and state standards. There may be at times, OT expectations based on business needs. This team does work holidays, which are rotated amongst the team members
Candidate Requirements Education/Certification Required: Requires graduated from an accredited school of nursing or A.D. or bachelor's in nursing Preferred: 2-4 years of related experience Licensure Required: LPN or RN, active in any state Preferred: Compact Years of experience required:

Must haves: Minimum 1 year nursing experience. Live anywhere in the U.S.

Nice to haves: Knowledge of Medicare and Medicaid regulations; Knowledge of utilization management

Disqualifiers:

Performance indicators: Metric driven in production and quality

• Top 3 must-have hard skills stack-ranked by importance

1 Ability to critically think 2 Ability to effectively use Microsoft OneNote and Word 3 Ability to work remotely, i.e. meet production deadlines; quality metrics Candidate Review & Selection

• Shortlisting process
• Candidate review & selection
• Interview information
• Onboard process and expectations

Projected Manager Candidate Review Date: 1-2 days post shortlisting
Type of Interviews:
1 teams meeting interview Required Testing or Assessment (by Vendor): NO