New

Clinical Review Nurse - Concurrent Review

Spectraforce Technologies

United States, Texas, Houston

Oct 28, 2026

Position Title: Clinical Review Nurse - Concurrent Review

Work Location: Remote, Compact Nursing License Required, Central Time Zone Work Schedule

Assignment Duration: 12-Month - Possible extension or conversion

Work Schedule: Mon-Friday, 11 AM to 8 PM CST; Weekends and Holidays on a rotation basis based on business needs. Possible 10-Hour, 4-day work week if it aligns with the candidate.

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.

Process denial letters for Medicaid Behavioral and Physical Health codes that will need prior authorization.

Experience with Co-Pilot a plus

Experience with Trucare Cloud a plus

Denial Letters for TX Medicaid Behavioral Health Codes

Daily Points are the measurement of production, must meet 100% production after training period

Will work within TruCare Cloud

Candidate Requirements
Education/Certification	Required: Required: Highschool Diploma, Nursing Degree- Associates or Above	Preferred:
Licensure	Required: Compact Nursing License-RN, LPN, LVN.	Preferred:
Years of experience required: 1+ years, Disqualifiers: Inability to work possible weekend hours and holidays on a rotation basis as applicable or needed by business needs Additional qualities to look for: MCO experience, specifically with Medicaid, True Care Cloud experience is a bonus, experience working remote
Top 3 must-have hard skills stack-ranked by importance	1	Ability to complete work independently and with minimal supervision after training.
2	Team player
3	Great organizational skills