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Concurrent Review RN
4 months ago
Concurrent Review Nurse Job Description As a Concurrent Review Nurse, you will review requests for service authorizations to assist with the utilization of appropriate medical services. Your responsibilities will include reviewing various medical treatments, services, home care, and out-of-plan referrals. You will assist with complex cases and internal process development, provide education to physicians and other team members on utilization review (UR) including appropriate admissions and placements, manage continuity of care, ensure safe transitions, patient and provider satisfaction, and appropriate length of stay. Hard Skills * Active nurse licensure in the state of Florida * Knowledge of case management and UR concepts * Utilization review of prior authorizations for medical necessity * Familiarity with and ability to apply InterQual criteria * Experience in a managed care facility, previously worked with a health insurance company Soft Skills * Ability to work under supervision * Effective communication skills * Capability to work as part of an interdisciplinary team Job Type This is a contract position with a duration of 6 Month(s). Work Site This is a hybrid position requiring some days on-site in SUNRISE, Florida and some days remote. Work Environment This role operates in a fast-paced environment under the supervision of a Medical Director and/or Medical Management supervisor. The shift timings are from 8:30 AM to 5:00 PM or 8:00 AM to 5:00 PM if an hour lunch is preferred. A hybrid work-from-home/office model is currently in place. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through: * Hiring diverse talent * Maintaining an inclusive environment through persistent self-reflection * Building a culture of care, engagement, and recognition with clear outcomes * Ensuring growth opportunities for our people The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
