Clinical - Clinical Review Nurse - Concurrent Review

Immediate need for a talented Clinical - Clinical Review Nurse - Concurrent Review. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-31977

Pay Range: $36 - $39/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Conduct concurrent clinical reviews to evaluate the medical necessity and appropriateness of ongoing healthcare services.
• Review medical records, clinical documentation, and treatment plans in accordance with established clinical guidelines and payer policies.
• Generate, process, and maintain provider and member correspondence related to preservice and concurrent reviews.
• Support denial management activities, including preparing and processing denial letters and maintaining accurate documentation.
• Utilize denial management systems, claims platforms, correspondence tools, and appeals tracking systems.
• Prioritize pending reviews, denial letters, escalations, and compliance-related deadlines.
• Monitor policy updates, payer communications, and internal updates that may affect review procedures.
• Collaborate with clinical review nurses, providers, and internal teams to address documentation gaps and review-related concerns.
• Maintain accurate records and ensure timely completion of assigned tasks in accordance with quality and productivity standards.
• Work independently in a remote environment while managing competing priorities and meeting performance expectations.

Key Requirements and Technology Experience:

• Experience in Utilization Management (UM), concurrent review, prior authorization, or denial management.
• Familiarity with medical necessity reviews, payer guidelines, claims systems, and appeals tracking.
• Experience preparing or processing clinical denial letters and provider/member correspondence.
• Strong written communication and clinical documentation skills.
• Active nursing license as an RN, as applicable to the role.
• Compact nursing license or qualifying licensure to support Louisiana (LA).
• 1–2 years of relevant nursing or clinical experience.
• Knowledge of medical terminology and clinical documentation.
• Strong multitasking, organizational, and time-management skills.
• Excellent attention to detail and ability to adapt to changing priorities.
• Ability to work independently in a remote environment.
• Availability to work one of the designated schedules, including rotating holidays.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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