What are the responsibilities and job description for the Clinical - Clinical Review Nurse - Concurrent Review position at Axelon Services Corporation?
Location : 100% Remote in TX Only
SHIFT : Monday-Friday (8am-5pm). No overtime will be required
Duration : 6 month, this position will be covering for a FTE who is out on leave.
Required Certifications :
TX RN License or Compact State License
Job Description :
- 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 1 business day. 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.
Describe the performance expectations / metrics for this individual and their team :
Will need to complete authorization reviews within 1 business day 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%.
Position Purpose : 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.
Education / Experience :
Requires Graduate from an Accredited School of Nursing or Bachelor s degree in Nursing and 2 4 years of related experience.
Required Skills / Experience :
Preferred Skills / Experience :
TX RN License or Compact State RN License
Utilization Management Experience
Communication skills
Clinical and Manage Care experience
Documentation skills / computer skills
Education Requirement :
Registered Nurse
Education Preferred :
TX Licensed RN / Compact State RN preferably BSN
Software Skills Required :
Microsoft and Excel
Required Certifications :
TX RN License or Compact State License
Required Testing :
