Concurrent Review Nurse

Position Title: Concurrent Review Nurse

Hours: 8am – 5pm M-F

Pay Rate: $42 - $43.97/hr

Location: Remote but you must reside in the state of California

Requirements:

· 3 years of hospital, managed care, or UM experience

· Strong computer skills – MS office and Zoom

· Active CA RN License

· 1 years’ experience with electronic medical records

· Knowledge of InterQual reviews preferred

Job Description:

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.

Responsibilities:

· Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member

· Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered

· Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines

· Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings

· Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members

· Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines

· Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities

· Collaborates with care management on referral of members as appropriate

· Performs other duties as assigned

· Complies with all policies and standards

#INDAS

Job Types: Full-time, Contract

Pay: $42.00 - $43.97 per hour

Expected hours: 40 per week

Experience:

• Clinical: 3 years (Required)
• Utilization review: 2 years (Required)
• EMR systems: 1 year (Required)
• MS office and Zoom: 1 year (Required)

License/Certification:

• California RN License (Required)

Work Location: Remote

Salary : $42 - $44