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Job description
Position Title: Clinical Review Nurse - Concurrent Review
Work Location: Remote-MS CST
Assignment Duration: 3 Months Contract to Hire
Work Schedule: 8 am-5 pm (Central). OT is voluntary; weekend rotation once every 2 months
Work Arrangement: Remote
Position Summary:
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.
Background & Context:
The Utilization Management team review members who are currently receiving inpatient services to ensure that care remains medically necessary, appropriate, and provided at the correct level of care. The review nurse assesses the member's clinical status, perform continued stay reviews, facilitate discharge planning and promote timely, appropriate care. The need is driven by needing to backfill FTE positions.
Key Responsibilities:
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
Qualification & Experience:
Candidate Requirements Education/Certification Required: Associate degree Preferred: Bachelor Licensure Required: Registered Nurse License (MS or Compact) Preferred: RN License Years of experience required: 2 years
Disqualifiers: LPN
Additional qualities to look for: Flexible, Results oriented Top 3 must-have hard skills stack-ranked by importance
1 Basic Computer Knowledge 2 Critical Thinking Skills 3 Time Management/Organized
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.