Clinical Review Nurse - Concurrent Review

Spectraforce Technologies

United States, North Carolina, Raleigh

500 West Peace Street (Show on map)

Jul 15, 2025

Title: Clinical Review Nurse - Concurrent Review

Duration: 06 Months with potential to extend

Location: TX Remote

10am-7pm CST, Schedule can be Sun-Thurs or Tues-Sat

Position Summary: The nurse will be reviewing about 20 cases a day to review for medical necessity on a member that admits to the hospital. Job is to advocate and protect the member from unnecessary admissions to the hospitals.

Key Responsibilities:

Nurse has to follow many changes and processes to complete the authorizations.
Will be working with a group of nurses to assist each other and collaborate on getting the cases done.
The nurse will be in contact with doctors and case managers to achieve decisions and/or receive more information about the member's condition/status.
Nurse will be using multiple resources we have to achieve successful completion of the cases.

Qualification & Experience:

Candidate Requirements
Education/Certification	Required: RN	Preferred:
Licensure	Required: RN,	Preferred:
Years of experience required Disqualifiers Best vs. average Performance indicators	Must haves: 2-4 years of hospital experience, multi tasking, time management, quick learner, go with the flow attitude, computer savvy Nice to haves: UM, Clinical/managed care experience Disqualifiers: unable to multi task, disorganized, not willing to make calls, not computer savvy Performance indicators: Will be monitoring productivity daily
Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection	1	TX RN license or compact state license
2	Communication skills
3	Documentation/Computer skills