Clinical - Clinical Review Nurse - Concurrent Review

Job description

Experience Required

n2 - 4 years

nMinimum Education Required

nBachelor's Degree

nCompensation

n$7.25 / hourly

nHours Per Week

n40

nNumber Of Positions

n1

nWork Schedule and Shift Requirements

nFirst (Day)

nJob Description

nPosition Title: Clinical Review Nurse

nWork Location: Remote- Nationally but must have Compact license if not in KY. Ok with all time zones but must work EST

nAssignment Duration: 6 months possibility of extension

nWork Schedule: Mon- Fri 8-5pm EST

nWork Arrangement: Remote

nPosition Summary:

nPerforms 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.

nBackground & Context: My team does concurrent reviews for KY Medicaid's inpatient medical stays. We have two employees going out on leave for 4-5 months at the end of this year and will need help while they are out. The team is small and tight knit. It is a busy market. There is potential for upcoming hiring needs depending on how the medical leaves play out.

nKey Responsibilities:

nnnPerforms concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care

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nnReviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member

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nnWorks with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered

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nnCollects, 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

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nnWorks with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings

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nnAssists with providing education to providers on utilization processes to ensure high quality appropriate care to members

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nnProvides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines

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nnReviews member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities

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nnCollaborates with care management on referral of members as appropriate

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nnPerforms other duties as assigned

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nnComplies with all policies and standards

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n nQualification & Experience:

nnRequired: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 - 4 years of related experience. * Preferred: BSN * Required: LPN * Preferred: RN * Years of experience required: 2-4 years of related experience. * Disqualifiers: no UM background- must be tech savvy * Additional qualities to look for: ICU, Med-surge, Acute Care experience preferred. * Top 3 must-have hard skills stack-ranked by importance 1 Extensive clinical background. 2 Technologically Savvy 3 Must be able to multi-task.

n nSPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of r ace, r eligion, color, s ex, national origin, age, s exual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at if you require reasonable accommodation.

nJob Type

nFull time

nBenefits Offered

nNot specified

nVeteran Preference

nNo

nPlace of Work

nOn-site

nRequisition ID

n5f21c -4d8a-b ba32b56

Worksite address

hopkinsville, KY, 42241, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.