Capital Staffing Solutions
via Indeed
Clinical Review Nurse- Remote(CA)
Compensation
$98K - 98K a year
Responsibilities
Perform concurrent utilization review of admitted patients using clinical knowledge and MCG guidelines to determine medical necessity and collaborate with medical staff within regulatory timelines.
Requirements
Requires clinical nursing experience in acute care settings such as Med Surg or ER, concurrent review experience, and proficiency with EMR platforms.
Full Description
Handling Concurrent review/Utilization Review Concurrent Review takes place while patient is receiving care while admitted to a facility. Bed side nurses make the best utilization review nurses. Not Post Service or case management We handle head in a bed (receiving care) patients to do concurrent review Looking for utilization management type candidates Top 3 skills • Clinical Exp • Acute care level exp • Med Surg, ER, etc nurses with Concurrent review exp EMR platform exp is needed Reviewing for medical Necessity all levels of care combining clinical knowledge and judgement with MCG guidelines. Rendering decisions and or upleveling to our in-house MD for review if the nurse is unable to approve. All of this to be done within regulatory turn around times. Our staff do not interact with members but work with the case managers and medical staff at the facilities. #AJ1 Pay: From $47.00 per hour Expected hours: 40.0 per week Benefits: • 401(k) • Dental insurance • Health insurance • Vision insurance Work Location: Remote
This job posting was last updated on 12/6/2025
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