We are currently seeking a highly skilled and motivated Remote Clinical Review Nurse/Concurrent Review Nurse (RN) to join our dynamic team. As a
Remote Clinical Review Nurse/Concurrent Review Nurse, you will be responsible for conducting concurrent reviews of patient care to ensure medical necessity and adherence to healthcare policies. Your role will involve evaluating clinical documentation and collaborating with healthcare providers and insurance companies to ensure the delivery of appropriate care.
Key Responsibilities:
Conduct concurrent reviews of patient care to assess the medical necessity of services and treatments.
Review clinical documentation to ensure compliance with healthcare policies and insurance guidelines.
Communicate with healthcare providers, patients, and insurance companies to gather necessary information and provide clarity on review requirements.
Maintain accurate and detailed records of review findings and decisions.
Stay updated on changes in healthcare policies, medical guidelines, and regulatory requirements.
Collaborate with internal teams to address any issues or concerns related to concurrent reviews.
Provide exceptional support and guidance to both patients and healthcare providers.
Qualifications
Active RN compact license in Texas.
2 years of clinical experience with prior authorization and/or utilization review.
Strong understanding of medical terminology, healthcare policies, and insurance guidelines.
Proficiency in using electronic health record (EHR) systems and other relevant software.
Utilization Management experience preferred
Clinical and Manage Care experience preferred
Work Site
This is a fully remote position but MUST reside in Texas.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
Hiring diverse talent
Maintaining an inclusive environment through persistent self-reflection
Building a culture of care, engagement, and recognition with clear outcomes
Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
Seniority level
Entry level
Employment type
Contract
Job function
Health Care Provider
Industries
Business Consulting and Services
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