Clinical Review Nurse (RN) – Concurrent Review

Immediate need for a talented Clinical Review Nurse (RN) – Concurrent Review. This is a 06+months contract opportunity with long-term potential and is located in Ohio(Remote). Please review the job description below and contact me ASAP if you are interested.
 
Job ID:25-84888
 
Pay Range: $34 - $39/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:

• 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.
• Performs concurrent reviews of member 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.
• Performs other duties as assigned, Complies with all policies and standards.
• The team has a low turnover and many seasoned staff.
• The purpose of this team is to review inpatient hospital requests for inpatient level of care.
• We work in coordination with care management on discharge planning. We are placing this request for staff for a nurse who is on leave.
• This is a temp to a possible perm position.
• We have a three-day turn-round time for our determinations; we need an extra staff member to assist to make sure we meet our requirements.
• Monday through Friday, 8 AM - 5 PM, no weekends, holidays or overtime. We have an ongoing team channel for communication as this is a remote position.
• Weekly huddles are completed to provide ongoing updates of changes or staff concerns.
• Nurses are assigned facilities to work with and will complete initial and continued stay reviews for members who are admitted to the hospital.
• There are a lot of unique situations and cases to learn about.
• We have weekly rounds for our inpatient admissions that stay over 10 days at the hospital to focus on discharge planning and needs with our Case Management team.
• This team has a low turnover rate and has a lot of character and internal team rapport.

Key Requirements and Technology Experience:

• Key Skills:RN License
• Concurrent Review
• ADN or BSN
• Requires Graduate from an Accredited School of Nursing or bachelor’s degree in nursing and 2 – 4 years of related experience. 2+ years of acute care experience required.
• Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred.
• Knowledge of Medicare and Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.
• Inpatient hospital experience, preferably UM review experience. Computer skills.
• Experience in Microsoft teams, outlook, and excel.
• 1.2 reviews per hour minimum.
• Inpatient Hospital experience
• UM Concurrent Review
• Ability to work in a remote environment .

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.
 
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