Clinical Review Nurse - Concurrent Review

Position Title: Clinical Review Nurse - Concurrent Review

Work Location: Remote

Assignment Duration: 12 months

Work Schedule: Monday - Friday 10:30 am CST - 7 pm CST

Position Summary:

This candidate will be working with the Tx Correspondence Team at Superior Health Plan. Tx Correspondence Team is part of Shared Services, which oversees many markets and states. The purpose of the team is to ensure that the members and requesting providers receive the written documentation of a denied service.

Background & Context:

This candidate will work with teams supporting The Organization's markets.

Key Responsibilities:

* The purpose of the team is to ensure that the members and requesting providers receive the written documentation of a denied service.

Qualification & Experience:

* Requires graduated from an accredited school of nursing or Bachelor's degree in nursing

* Preferred: 2-4 years of related experience

* Licensure Required: LPN or RN - Compact as long as the licensure is unrestricted we are okay

* Preferred: Compact

* Must haves: Minimum 1 year nursing experience

* Nice to haves: Knowledge of Medicare and Medicaid regulations; Knowledge of utilization management

* Disqualifiers: n/a

* Performance indicators: Metric driven in production and quality

* Top 3 must-have hard skills stack-ranked by importance:

1. 
   

   Ability to critically think

   
   
2. 
   

   Ability to effectively use Microsoft OneNote and Word

   
   
3. 
   

   Ability to work remotely, i.e., meet production deadlines; quality metrics

   
   
   
   
   
   
   

   Candidate Requirements
   Education/Certification	Required: Requires graduated from an accredited school of nursing or Bachelor's degree in nursing	Preferred: 2-4 years of related experience
   Licensure	Required: LPN or RN - Compact as long as the licensure is unrestricted we are okay	Preferred: Compact
   Must haves: Minimum 1 year nursing experience. Nice to haves: Knowledge of Medicare and Medicaid regulations; Knowledge of utilization management Disqualifiers: n/a Performance indicators: Metric driven in production and quality
   Top 3 must-have hard skills stack-ranked by importance	1	Ability to critically think
   2	Ability to effectively use Microsoft OneNote and Word
   3	Ability to work remotely, i.e. meet production deadlines; quality metrics