What are the responsibilities and job description for the CLINICAL REVIEW NURSE - CONCURRENT REVIEW position at Pyramid Consulting, Inc.?
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 :
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.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
prof
Salary : $36 - $40
