Job Description

Job Title: Concurrent Review Nurse

Location: 100% Fully Remote (Must reside and hold an active RN license in California)
Schedule: Monday-Friday, 8:00 AM - 5:00 PM PST

Compensation:

Hourly rate: $40-$42 based on experience
Benefits available to full-time employees after 90 days of employment
401(k) with company match available for full-time employees after one year of service
Qualifications:

Current RN license in California
Must reside in California
2-4 years of experience in hospital settings, managed care, or utilization management (UM)
Familiarity with healthcare and managed care systems is preferred
Knowledge of Medicare and Medicaid utilization review processes
Strong computer skills and experience with operating systems, particularly Microsoft Systems; experience with TruCare is a plus
Responsibilities:
As a Concurrent Review Nurse, your primary role will be to enhance the quality and cost-effectiveness of medical care by utilizing your clinical expertise and applying relevant policies and guidelines during the review process for emergent/urgent and continued stay requests. Your key responsibilities will include:

Reviewing concurrent and continued stay requests to ensure appropriate care and setting, adhering to established guidelines and policies. Approve services or escalate requests to the appropriate Physician or Medical Director for secondary review.
Conducting medical necessity and level of care reviews for requested services using InterQual guidelines, referring to Medical Directors for further evaluation as needed.
Collaborating effectively with various staff within provider networks and the discharge planning team, both electronically and telephonically, to coordinate member care.
Participating in discharge planning and educating providers about utilization and medical management processes.
Serving as a clinical resource and providing clinical knowledge to non-clinical team members.
Accurately entering and maintaining pertinent clinical information in various medical management systems.
If you are passionate about improving patient care and thrive in a collaborative, remote environment, we encourage you to apply for this exciting opportunity!
Employment Type: Full-Time
Salary: $ 40.00 42.00 Per Hour

Job Tags

Hourly pay, Full time, Immediate start, Monday to Friday,

Similar Jobs