New

Clinical Review Nurse - Concurrent Review

Spectraforce Technologies

United States, Texas, Houston

Jan 27, 2026

Title: Clinical Review Nurse - Concurrent Review

Duration: 06 Months - Contract to hire

Location: Remote TX

Tuesday - Saturday | 8am-5pm CST- schedule is firm- no flexibility

Position Purpose:

Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.

Responsibilities

Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care
Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member
Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered
Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines
Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings
Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members
Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines
Reviews member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities
Collaborates with care management on referral of members as appropriate
Performs other duties as assigned
Complies with all policies and standards

Candidate Requirements
Education/Certification	Required: Graduate from an Accredited School of Nursing or bachelor's degree in nursing	Preferred: 2 - 4 years of related experience- 4 years is preferred
Licensure	Required: Texas RN	Preferred:
Years of experience required: UM experience preferred not required Disqualifiers: Less than 2 years of nursing experience, no LPNs Additional qualities to look for: Multitasking, fast learner, positive, and be computer savvy.
Top 3 must-have hard skills stack-ranked by importance	1	Multitasking
2	Fast learner
3	Computer savvy