Job Description :
Job Title : Clinical Review Nurse - Concurrent Review
Location : Remote - TX
Duration : 6 months (Possible Extension)
Shift Timing : Monday through Friday 8am to 5pm (CST)
Note :
Candidate Must have TX RN License or Compact State RN License.
Utilization Management / PA Expeince Experience
Documentation skills / computer skills
Clinical and Manage Care experience
Job Summary :
Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD) :
- 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 the 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%. CRN should also be completing any Enterprise Compliance courses timely within Centene University.Tell me about what their first day looks like :
The first day will consist of onboarding. They will meet with IT to log into VPN and Trucare. They will be saving links and job aids, meet with people leader and preceptor to go over expectations, processes, calendar, and they end up shadowing their preceptor for the remaining part of the day. They will go through a learning journey with corporate that usually begins later that week. They will have a training instructor and days are planned out for them. During this learning journey they will get information about Trucare Classic and how to review authorizations within Interqual. The last week of the learning journey will consist of them learning the TX specific line of business. Throughout the learning journey they will have some shadow time, precepting time, and independent work.What previous job titles or background work will in this role?
Registered Nurse, Concurrent Review, Utilization Management experience is preferred. They need to have strong computer, documentation, and communication skills. They will be toggling between different screens. They would need to catch on fast. Our Texas volume is high. If they have InterQual experience that's a plus. They must possess a TX RN License or Compact State RN license. If not InterQual experience would prefer someone with a critical care background (min of at least 3 years at the bedside)
