Concurrent Review Nurse

2 weeks ago


French Camp, Mississippi, United States Health Plan San Joaquin Full time
Job Summary

We are seeking a skilled Concurrent Review Nurse to join our team at Health Plan San Joaquin. As a key member of our Long-Term Care team, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.

Key Responsibilities
  • Conduct concurrent reviews of inpatient activities to ensure compliance with HPSJ, regulatory, and contractual requirements.
  • Collaborate with providers to resolve care issues and make timely recommendations regarding transfers, level of care, and discharge planning.
  • Research and resolve adjudication issues in an accurate and timely manner.
  • Document activities in HPSJ systems according to standards and track data as required.
Requirements
  • Graduation from an accredited nursing school.
  • At least three years of clinical experience as an RN in a hospital or clinic.
  • Acute care or Skilled Nursing experience.
  • Long Term Care experience.
Preferred Qualifications
  • Experience in case management, utilization management, or discharge planning.
  • Experience as a clinician in a managed care setting.
  • Experience working with Medi-Cal and/or MediCare populations.
What We Offer
  • Competitive salary.
  • Robust and affordable health/dental/vision benefits.
  • Generous paid time off and holidays.
  • CalPERS retirement pension program.
  • Education and training reimbursement.

We are an equal opportunity employer and value diversity and inclusion in the workplace. If you are a motivated and detail-oriented individual who is passionate about delivering high-quality care, we encourage you to apply for this exciting opportunity.



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