Clinical Review Nurse - Concurrent Review

Position Title: Clinical Review Nurse - Concurrent Review

Work Location: Remote - TX

Assignment Duration: 6-month Contract to Hire

Work Schedule: Tuesday-Saturday, 8am-5pm CST

Work Arrangement: Remote

Position Summary:

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.

Key Responsibilities:

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  Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care

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

  
  
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  Works with Medical Affairs and/or Medical Directors to discuss member care

  
  
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  Collects, documents, and maintains concurrent review findings and discharge plans in health management systems

  
  
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  Works with healthcare providers to approve medical determinations or provide recommendations

  
  
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  Provides education to providers on utilization processes

  
  
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  Reviews member transfer or discharge plans for timely transitions

  
  
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  Collaborates with care management on referrals

  
  
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  Performs other duties as assigned

  
  
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  Complies with all policies and standards

  
  
  
  
  
  
  

  Candidate Requirements
  Education/Certification	Required: RN	Preferred: BSN, ICU/ER experience
  Licensure	Required: TX RN License or Compact State License	Preferred: n/a
  Years of experience required: Minimum of 3-4 years' experience as a nurse. Disqualifiers: Not willing to work the Tuesday-Saturday Schedule 8am-5pmCST. They can't be homeschooling while working this job. They need to know the volume is high, they will spend a lot of time on computer working authorizations. It is very busy and home/childcare distractions will affect their productivity. Performance indicators: Must haves: Microsoft and Excel Best vs. average: Nice to haves: ICU-ER experience**, UM Experience, CM Experience would be nice but not required. The ICU/ER experience will help them with acuity and volume of cases. Additional qualities to look for:
  Top 3 must-have hard skills stack-ranked by importance	1	TX RN License or compact State RN License.
  2	Strong communication/computer skills
  3	Strong documentation skills