Clinical Review Nurse - Concurrent Review - J00933

Location: 100%Remote- Nationally but must have Compact license if not in KY...Ok with all time zones but must work EST

SHIFT:Mon- Fri 8-5pm EST. Rotating weekends (one weekend every 5-6 weeks Sat and Sun)

Duration: 6 months, possible extension.

Position Purpose: This team does concurrent reviews for KY Medicaids inpatient medical stays. This is a position to help with the Marketplace and Medicaid line of business due to volume. The team is small and tight knit. It is a busy market. There is potential for upcoming hiring needs depending on how the medical leaves play out

Description: Job Profile Summary Performs :19-21 reviews concurrent reviews a day, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.

Candidate Requirements
Education/Certification	Required: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 4 years of related experience.			Preferred: BSN
Licensure	Required: LPN			Preferred: RN
Years of experience required: 2-4 years of related experience. Disqualifiers: no UM background- must be tech savvy Additional qualities to look for: ICU, Med-surge, Acute Care experience preferred. Required Testing or Assessment (by Vendor): Typing test, basic computers skills test 40-50 wpm
Top 3 must-have hard skills stack-ranked by importance		1	Extensive clinical background.
		2	Technologically Savvy
		3	Must be able to multi-task.