Clinical - Clinical Review Nurse - Concurrent Review

Job Description

Job Description

Immediate need for a talented Clinical - Clinical Review Nurse - Concurrent Review. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-33642

Pay Range: $36.50 - $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:

• Conduct concurrent reviews of inpatient medical stays to evaluate medical necessity and appropriate levels of care.
• Assess members' clinical conditions, acuity levels, resource utilization, and length of stay.
• Review and support discharge planning to facilitate timely transitions between care settings and facilities.
• Collaborate with healthcare providers, Medical Affairs, and Medical Directors regarding clinical findings and medical determinations.
• Document review findings, discharge plans, and follow-up actions accurately in health management systems.
• Coordinate with care management teams for appropriate member referrals.
• Provide guidance to providers regarding utilization management processes and applicable clinical guidelines.
• Identify opportunities to improve care quality, continuity, and appropriate resource utilization.

Key Requirements and Technology Experience:

• BSN qualification.
• Background in ICU, medical-surgical nursing, acute care, or inpatient clinical settings.
• Experience with concurrent reviews, medical necessity assessments, and discharge planning.
• Graduate of an accredited nursing school or a bachelor's degree with 2–4 years of related experience.
• Active RN license issued by Kentucky or a valid multistate compact nursing license.
• Previous utilization management experience is required.
• Strong clinical assessment and critical-thinking skills.
• Excellent computer proficiency and the ability to navigate clinical documentation systems.
• Strong multitasking, organizational, and time-management abilities.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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, colour, 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.

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