Concurrent Review Nurse

3 weeks ago

San Diego, United States A-Line Staffing Solutions Full time $40 - $42
Job DescriptionJob Description

A-Line staffing is hiring a Fully Remote Concurrent Review Nurse in California

If interested APPLY NOW for IMMEDIATE consideration

Concurrent Review Nurse Details:

  • Location: 100% Fully Remote – must live and be licensed in state of California
  • Schedule: Monday-Friday 8:00am-5:00pm PST

Concurrent Review Nurse Compensation

  • The pay for this position is $40-$42 per hour based on experience
  • Benefits are available to full-time employees after 90 days of employment
  • A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates

Concurrent Review Nurse Qualifications:

  • Active RN license in the state of California
  • Must reside in California
  • 2-4 years of hospital, managed care, UM experience required
  • Knowledge of healthcare and managed care preferred
  • Knowledge of Medicare and Medicaid Utilization Review processes
  • Must have solid computer skills
  • Experience with computer operating systems; Microsoft Systems, experience with TruCare is beneficial.

Concurrent Review Nurse Responsibilities:

Summary: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.

·       Perform review of concurrent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director for secondary review.

·       Complete medical necessity and level of care reviews for requested services using InterQual guidelines and refer to Medical Directors for review depending on case findings.

·       Collaborate with various staff within provider networks and discharge planning team electronically and telephonically to coordinate member care.

·       Conduct discharge planning. Educate providers on utilization and medical management processes.

·       Provide clinical knowledge and act as a clinical resource to non-clinical team staff. 

·       Enter and maintain pertinent clinical information in various medical management systems.

If interested APPLY NOW to Chris Meyer for IMMEDIATE consideration

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