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Concurrent Review Nurse Jobs (NOW HIRING)

Leon Medical Centers

Concurrent Review Nurse

Doral, FL · On-site

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.

Leon Medical Center

NY · On-site

$80 - $100/hr

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.

Leon Health Plan

Concurrent Review Nurse

Doral, FL · On-site

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.

iPlace USA

Concurrent Review Nurse

Bedford, NH

Perform onsite review of emergent/urgent and continued stay requests Qualifications * 2+ years of clinical nursing experience in an acute care. * Current state's RN license. Additional Information ...

iPlace USA

Concurrent Review Nurse

Bedford, NH · On-site

Perform onsite review of emergent/urgent and continued stay requests Qualifications * 2+ years of clinical nursing experience in an acute care. * Current state's RN license. Additional Information ...

Centene

Clinical Review Nurse - Concurrent Review

$27.02 - $48.55/hr

The position is remote/work from home; applicants must hold an IL RN licensure. The position is supporting Utilization Management/Concurrent Review for the YouthCare program. The position supports ...

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How much do concurrent review nurse jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for concurrent review nurse in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a concurrent review nurse?

A Concurrent Review Nurse is a healthcare professional responsible for evaluating patient care and treatment plans in real time to ensure they meet medical necessity and insurance guidelines. They work with healthcare providers and insurance companies to review hospital stays, procedures, and treatments while patients are still receiving care. Their goal is to ensure appropriate resource utilization, prevent unnecessary costs, and support positive patient outcomes. These nurses must have strong clinical knowledge, critical thinking skills, and familiarity with insurance policies and regulations. They often collaborate with case managers, physicians, and insurance representatives to coordinate care efficiently.

What are the typical daily responsibilities of a concurrent review nurse?

A Concurrent Review Nurse is responsible for reviewing patient admissions and ongoing hospital stays to ensure medical necessity and adherence to insurance guidelines. Daily tasks often include analyzing clinical documentation, communicating with treating physicians, and coordinating with case managers and insurance representatives. You may also need to document findings in electronic health records and help facilitate timely transitions of care or discharge planning. This role requires regular collaboration with both clinical teams and administrative staff to support quality patient outcomes and efficient healthcare delivery.

What are the key skills and qualifications needed to thrive in the concurrent review nurse position?

To thrive as a Concurrent Review Nurse, you need strong clinical assessment skills, a current RN license, and a good understanding of healthcare regulations and utilization management. Proficiency with case management systems, electronic health records (EHRs), and familiarity with Medicare/Medicaid guidelines are highly valued. Excellent attention to detail, critical thinking, and effective communication skills help you succeed in fast-paced, multidisciplinary settings. These abilities are vital for ensuring appropriate care delivery, meeting compliance standards, and facilitating collaboration between healthcare providers and insurance companies.

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Concurrent Review Nurse jobs near you
Infographic showing various Concurrent Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Concurrent Review Nurse

Leon Medical Centers

Doral, FL • On-site

Full-time

Posted 24 days ago

Job description

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care. This is achieved through the review of inpatient admissions, outpatient precertification, and prior authorization requests, using established medical policies, evidence-based guidelines, and managed care standards.

Essential Duties and Responsibilities
  • Lead, train, and support both clinical and non-clinical staff in accordance with Leon Health's policies and procedures to ensure efficient and effective performance.
  • Monitor and respond to incoming calls and written inquiries from members, providers, and internal departments.
  • Oversee the quality, accuracy, and timeliness of prior authorization reviews and ensure appropriate prioritization.
  • Enter service requests and determination data into the appropriate systems in compliance with regulatory requirements and organizational policies.
  • Review clinical documentation for precertification and concurrent (ongoing) reviews.
  • Perform on-site and/or telephonic reviews to determine the appropriateness of inpatient and outpatient care settings, using medical policies, CMS guidelines, and industry standards.
  • Conduct medical and behavioral health (BH) reviews for pre- and post-service authorization requests.
  • Issue authorizations for inpatient admissions, outpatient services, and post-service requests to providers, facilities, and members as applicable.
  • Refer complex cases to a Medical Director or Behavioral Health Practitioner when additional clinical evaluation is required.
  • Ensure all documentation is complete, accurate, and clearly supports authorization decisions.
  • Process denial determinations in compliance with regulatory standards and internal policies.
  • Maintain up-to-date census reports, daily notes, and authorization records, including tracking admissions and discharges.
  • Collaborate with healthcare providers to obtain necessary clinical documentation for medical necessity determinations.
  • Work with providers to proactively identify discharge needs and assist in care planning.
  • Facilitate smooth care transitions across the healthcare continuum by coordinating with facilities and the Care Management team.
Education
  • Bachelor's degree in Nursing required
Experience
  • Minimum of two (2) years of experience in clinical review or utilization management
Language Skills
  • Bilingual in English and Spanish (required)

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