Clinical Review Nurse

Established in 2000, LanceSoft is a pioneer in delivering top-notch Global Workforce Solutions and IT Services to a diverse clientele. As a Certified MBE and Woman-Owned organization, we pride ourselves on fostering global cross-cultural connections that advance both the careers of our employees and the success of our clients' businesses. At LanceSoft, our mission is clear: to leverage our global network to seamlessly connect businesses with the right talent and individuals with the right opportunities, all without bias. We believe in providing Global Workforce Solutions with a personalized, human touch. Our comprehensive range of services spans various domains, encompassing temporary and permanent staffing, Statement of Work (SOW) arrangements, payrolling, Recruitment Process Outsourcing (RPO), application design and development, program/project management, and engineering solutions. Currently, our team of over 5,000 professionals caters to 110+ enterprise clients worldwide, including Fortune companies. Our client base represents a diverse spectrum of industries, including Banking & Financial Services, Semiconductor/VLSI, Technology, Healthcare & Life Sciences, Government, Telecom & Media, Retail & Distribution, Oil & Gas, and Energy & Utilities. Headquartered in Herndon, VA, LanceSoft operates 32+ regional offices across the North America, Europe, Asia, and Australia. We also have nine delivery centers strategically located in India in Bangalore, Indore, Noida, Baroda, Hyderabad, Bhubaneshwar, Dehradun, Goa, and Aligarh to further enhance our client service capabilities.

Title: Clinical Review Nurse Duration: 3+ months Schedule: After training & onboarding (about 6 weeks) the schedule 2 temps will be Sunday-Thursday and 2 will be Tuesday-Saturday 8am to 5pm PST Pay Rate: $43.06/hr. On W2 (All Inclusive) Location: 100% Remote Must be located: AZ, FL, GA, ID, IA, KY, MI, NE, NY, OH, TX, UT, WA, WI, NV. General Information Job Description: Must align with Client Healthcare competencies. Able to complete and maintain a daily productivity rate of 15 authorizations a day for concurrent review or 20 authorizations a day for prior authorization. Highly organized. Strong clinical assessment skills. Excellent attention to detail, critical thinking, and effective communication skills in this fast-paced, multidisciplinary setting. Ensures appropriate care delivery, meeting compliance standards, and facilitating collaboration between healthcare providers. Unrestricted Registered Nurse licensure within Nevada upon hire or within 90 days of starting. Summary: Works with the Utilization Management team, primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Client Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures, providing prior authorizations and/or concurrent review. Assesses services for Client Members to ensure optimum outcomes, cost effectiveness, and compliance with all state and federal regulations and guidelines.

Provides concurrent review and prior authorizations (as needed) according to Client policy for Client members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Client members, including Behavioral Health and Long Term Care. Maintains department productivity and quality measures. Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to Client medical directors regularly, as necessary. Complies with required workplace safety standards.