Concurrent Review Registered Nurse (RN)

Job overview

The Concurrent Review Registered Nurse (RN) role is fully remote, with work hours aligned to CST business hours; Henderson, NV is the listing location. Compensation is not specified. The role supports the client’s Utilization Management team. The nurse evaluates medical necessity and coordinates utilization reviews, discharge planning, and transitions of care. Through collaboration with providers and internal teams, the role supports appropriate, cost-effective, evidence-based care and quality improvement.

What you'll do

• Perform concurrent, prior authorization, and retrospective utilization reviews
• evaluate medical necessity using InterQual, MCG, CMS, LCD/NCD, and health plan guidelines
• coordinate discharge planning and transitions of care
• collaborate with physicians, hospital staff, specialists, and care management teams
• request and review clinical documentation
• escalate complex cases to the Medical Director
• educate providers on utilization management policies and criteria
• document reviews and decisions
• identify care gaps and support quality improvement
• serve as a clinical resource.

What we're looking for

Skills & competencies

concurrent review registered nurse

remote

henderson nv

impresiv health

utilization management

prior authorization

medical necessity review

discharge planning

transitions of care

interqual

mcg

cms guidelines

registered nurse

Work arrangement

• Weekend coverage required

Why this role

Requires an active RN license and ability to obtain licensure in multiple states, at least four years of clinical nursing experience, at least two years of managed care or HMO experience, and experience with evidence-based medical necessity reviews.

About the employer

Impresiv Health is hiring for this role. Industry: Administrative Management and General Management Consulting Services. Sector: 54.