Clinical - Clinical Review Nurse - Concurrent Review

Immediate need for a talented Clinical Review Nurse - Concurrent Review. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote) . Job ID:26-31575 Pay Range: $35.80 - $39.10/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: Perform concurrent reviews of members to determine overall health and appropriate level of care. Review quality and continuity of care by assessing acuity levels, resource consumption, length of stay, and discharge planning. Collaborate with Medical Affairs and/or Medical Directors to discuss member care. Document and maintain concurrent review findings and discharge plans in health management systems. Work with healthcare providers to approve medical determinations based on concurrent review findings. Educate providers on utilization processes to ensure high-quality care. Provide feedback to leadership on opportunities to improve care levels and medical necessity. Review member transfer or discharge plans to facilitate timely discharges. Collaborate with care management for appropriate member referrals. Maintain productivity standards of an average of 14 reviews per day, with a weighted productivity target of 95% and audit scores above 95%. Key Requirements and Technology Experience: 2-4 years of related experience, with a minimum of 2 years in acute care required; experience in utilization management or managed care preferred. Required: Accredited School of Nursing or bachelor’s degree in nursing. Required: RN licensure. Clinical knowledge to determine overall health and treatment needs of members. Knowledge of Medicare and Medicaid regulations preferred. Familiarity with utilization management processes preferred. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #J-18808-Ljbffr Pyramid Consulting