What are the responsibilities and job description for the Utilization Review Nurse position at IMCS Group?
Job Title: Clinical Review Nurse-Concurrent Review
Duration: 6 months contract
Work Location: Texas - 100% Remote
Shift: Monday through Friday 8am to 5pm . (Every other month will work one Saturday a month)
Pay rate : $38 to $42 per hour.
Day to day responsibilities of this the role:
- 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 24-hours.
- If criteria do 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.
- Will need to complete authorization reviews within 24-hour 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 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%.
Required Skills/Experience:
- ICU-ER experience (Preferred)
- UM Experience.
- CM Experience. (Preferred)
- Strong communication/computer Skills.
- Strong documentation skills.
Education Requirement:
- Bachelor of Science in Nursing (Preferred)
Required Certifications:
- TX RN License or Compact State License.
Salary : $38 - $42
