Clinical Review Nurse - Concurrent Review

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