Pacer Group
Clinical Review Nurse Concurrent Review
Pacer Group, Granite Heights, Wisconsin, United States
Position Title
Clinical Review Nurse - Concurrent Review Location
Remote Duration
12 Months Schedule
Monday through Friday, 9:30 AM to 6:00 PM CST Position Summary
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. Key Responsibilities
Working within a highly engaged team remotely, with ongoing support to produce denial correspondence based on the review that is in easy-to-understand language to the member and adheres to the NCQA and state standards. The team may work holidays, which are rotated among the members. This team supports the day‑to‑day deadlines, fostering a culture of Service, Accountability, and Trust. The role helps ensure the member understands why a service has been denied, which can further strengthen the relationship between the member and the provider. Candidate Requirements
Education/Experience:
Graduate of an accredited school of nursing or hold a Bachelor’s degree in nursing. LPN or RN, Texas or Compact. Must haves:
Minimum 1 year nursing experience. Nice to haves:
Knowledge of Medicare and Medicaid regulations; utilization management; critical thinking; proficiency in Microsoft OneNote and Word; ability to work remotely and meet production deadlines; strong quality metrics focus. Seniority level
Entry level Employment type
Full-time Job function
Health Care Provider Industries
Staffing and Recruiting
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Clinical Review Nurse - Concurrent Review Location
Remote Duration
12 Months Schedule
Monday through Friday, 9:30 AM to 6:00 PM CST Position Summary
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. Key Responsibilities
Working within a highly engaged team remotely, with ongoing support to produce denial correspondence based on the review that is in easy-to-understand language to the member and adheres to the NCQA and state standards. The team may work holidays, which are rotated among the members. This team supports the day‑to‑day deadlines, fostering a culture of Service, Accountability, and Trust. The role helps ensure the member understands why a service has been denied, which can further strengthen the relationship between the member and the provider. Candidate Requirements
Education/Experience:
Graduate of an accredited school of nursing or hold a Bachelor’s degree in nursing. LPN or RN, Texas or Compact. Must haves:
Minimum 1 year nursing experience. Nice to haves:
Knowledge of Medicare and Medicaid regulations; utilization management; critical thinking; proficiency in Microsoft OneNote and Word; ability to work remotely and meet production deadlines; strong quality metrics focus. Seniority level
Entry level Employment type
Full-time Job function
Health Care Provider Industries
Staffing and Recruiting
#J-18808-Ljbffr