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 Dallas,TX(Remote). Please review the job description below and contact me ASAP if you are interested.
 
Job ID:25-71194
 
Pay Range: $35 - $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:

• They will be responsible for looking over handwritten and computer-generated documents while prioritizing tasks effectively. 
• TX has a very tight time frame and authorization reviews are expected to be completed within 24-hours. 
• If criteria does not meet medical necessity for an inpatient stay, the nurse is expected to send to a medical director for review. 
• If an authorization is denied the nurse will be expected to follow up with UM department (by phone/fax) at hospital to offer a peer to peer before sending an official denial.   
• Will need to complete authorization reviews within 24-hour TAT. 
• The nurse is expected to work about 12-20 auths per day. 
• They will get a mixture of new and concurrent reviews. 
• The goal is to reach individual hourly weighted productivity of 2.49-3.21 in order to meet expectations. 
• If the authorization doesn’t meet medical necessity criteria, CRN  should be sending to MD. 
• Concurrent Review Referral Rate should be 30%-40%. 
• CRN should also be completing any Enterprise Compliance courses timely within University.
• The first day will consist of onboarding.
• They will meet with IT to log into VPN and Trucare. 
• They will be saving links and job aids, meet with people leader and preceptor to go over expectations, processes, calendar, and they end up shadowing their preceptor for the remaining part of the day. 
• They will go through a learning journey with corporate that usually begins later that week. 
• They will have a training instructor and days are planned out for them. 
• During this learning journey they will get information about Trucare Classic and how to review authorizations within Interqual. 
• The last week of the learning journey will consist of them learning the Ambetter specific line of business. 
• Throughout the learning journey they will have some shadow time, precepting time, and independent work.  

Key Requirements and Technology Experience:

• Key Skills: Utilization Review
• Prior Authorization
• Utilization Management
• TX RN License or Compact State RN License,
• Strong communication/computer Skills .
• Strong documentation skills .
• ICU or ER background experience, Utilization Management experience. 
• They need to have strong computer, documentation, and communication skills.
• They will be toggling between different screens. 
• They would need to catch on fast.  Our Texas volume is high. 
• If they have InterQual experience and know the Ambetter line of business that’s a plus.  
• They must possess a TX RN License or Compact State RN license.
• Microsoft and Excel .
• ICU-ER experience, UM Experience, CM Experience .

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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