Clinical Review Nurse Inpatient Concurrent Review

About the Role

Join a dynamic team in a brand new 2026 program dedicated to managing the Duals line of business, combining Medicare and Medicaid benefits into a single comprehensive service. This program operates in eight states and may expand further in 2027. The role involves managing the complexities of both Medicare and Medicaid requirements simultaneously, focusing on inpatient concurrent reviews.

Responsibilities

• Conduct inpatient concurrent reviews, averaging 2 reviews per hour
• Manage both Medicare and Medicaid requirements effectively
• Perform clinical reviews
• Utilize InterQual for medical management and decision-making
• Ensure compliance with managed care policies and procedures

Qualifications

• Registered Nurse (RN) with a compact license
• Experience in Utilization Management (UM)
• Proficient in concurrent review
• Strong computer skills and ability to use medical management software
• Ability to perform real-time (Concurrent) review of inpatient cases
• Strong understanding of medical necessity guidelines, such as InterQual or MCG
• Skilled at interpreting clinical documentation and determining appropriate levels of care
• Experience in acute care, Medicaid, and Medicare

Schedule

Training lasts approximately two weeks, followed by mentorship from a preceptor. Work hours start around 9 or 10 AM, with the ability to work as late as 7 PM, and you must work within your time zone. Candidates in Central, Pacific, and Mountain time zones are preferred. Schedule: Tuesday-Saturday OR Sunday-Thursday, 8 to 5pm, Mountain time.

Pay

The pay range for this position is $34.00 - $40.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Benefits

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Job Type & Location

This is a Contract to Hire position based out of St. Louis, MO.