Clinical Review Nurse - Concurrent Review

Immediate need for a talented Clinical Review Nurse - Concurrent Review. This is a 06 Months Contract opportunity with long-term potential and is located in TX(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-56634

Pay Range: $36 - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).Additional Mileage reimbursement.

Key Responsibilities:

• 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 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.
• 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 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 University.

Key Requirements and Technology Experience:

• Skills-Utilization Management, ICU, CM.
• ICU or ER background experience, Utilization Management experience.
• 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 and know the Ambetter line of business that’s a plus. They must possess a TX RN License or Compact State RN license.
• TX RN License or Compact State RN License,
• Strong communication/computer Skills
• Strong documentation skills
• ICU-ER experience
• UM Experience
• CM Experience
• Education Requirement: Registered Nurse
• Education Preferred: BSN, ICU/ER experience
• Required Certifications: TX RN License or Compact State License.
• Strong documentation, and communication skills.
• Microsoft and Excel.
• Location: TX Remote.
• Shift Time & Working Days: Monday through Friday 8am to 5pm (CST).

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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