Clinical Review Nurse - Concurrent Review

Immediate need for a talented Clinical Review Nurse - Concurrent Review . This is a 06 months Contract (Possible Extension & Conversion to FTE) opportunity and its US (Remote) . Please review the job description below and contact me ASAP if you are interested.
 
Job Diva ID: 26-07532
 
Pay Range: $38 - $42/hr . (Mileage reimbursement) . 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:

• Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities
• Productivity 17-20 reviews a day and quality expectations must be met
• Partners with interdepartmental teams on projects within utilization management as part of the clinical review team
• Partners and works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered
• Assesses members and/or families for post discharge needs and provide education on discharge planning options based on diagnoses, prognoses, resources, and/or preferences
• Manages 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
• Manages and collaborates with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings
• Provides education to providers on utilization processes to ensure high quality appropriate care to members
• Partners with leadership to identify opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines
• Oversees concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care
• Provides insight and guidance on concurrent reviews to determine overall health of member, review the type of care being delivered to member, and approving treatment needs including discharge planning
• Provides guidance and expert knowledge, as appropriate, to utilization management team to address issues and validate the necessity and setting of care being delivered to the member
• Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member
• Oversees 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
• Provides subject matter expertise based on prior experience as well as training to other team members
• Manages reporting to identify trends and provides recommendations to various teams
• Performs other duties as assigned
• Complies with all policies and standards

Key Requirements and Technology Experience: 

• Key Skills: Case Management, RN, Utilization Management, Concurrent Review
• 2 – 4 years of related experience - concurrent review / interqual experience
• Trucare experience
• Communication skills a must
• FAST PACED, attention to detail, tech savvy
• Interqual, one note, word, excel, teams,
• ADN or above, Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience
• Required: California RN license ONLY

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

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