Clinical Review Nurse -Concurrent Review

Position Title: Clinical Review Nurse - Concurrent Review

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

Duration: 12 Months

Schedule: Friday-Tues, 2 pm-10 pm CST, 40 hours/week.

So, either five 8-hour shifts until 10 PM EST, Friday-Tues, OR four 10-hour shifts until 10 pm EST, Sat-Tues

PR: $35-45.00/HR

Key Responsibilities

• Performs concurrent reviews of members for appropriate care and setting to determine overall health and appropriate level of care

• Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member

• Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered

• Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines

• Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings
• Assists with providing education to providers on utilization processes to ensure high-quality appropriate care to members
• Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines
• Reviews member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities
• Collaborates with care management on referral of members as appropriate

Education/Certification Required:

• Requires graduated from an accredited school of nursing or Bachelor's degree in nursing

Licensure Required:

• Compact Nursing License-RN, LPN, LVN.

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

Skills :

• Ability to complete work independently and with minimal supervision after training.

• Team player

• Great organizational skills