Field IP Concurrent Review Nurse

Health Care Support Staffing, Inc. (HSS), is a proven industry‑leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non‑clinical positions with some of the largest and most prestigious healthcare facilities including:
Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. Health Care Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long‑lasting and rewarding career!

Responsibilities will include, but are not limited to:

• Identifying inpatient, observation, acute rehabilitation, skilled nursing facility and custodial admissions and discharges by utilizing the following processes:
  • The Plan’s daily census
  • The hospital’s individual Plan admission log (if available)
  • Inquiring Plan admissions/discharges through the admission/ER department offices
  • Direct notification by the member’s PCP or family member
  • Contacting the Plan’s hospitalist program, if available
• Initiates a concurrent review assessment within one working day of admission notification to determine initial and continued length of stay
• Identifies admissions that do not meet the requested level of care (i.e., full admission vs. observation for a hospital facility, inappropriate skill level for a SNF, etc.) and contacts the attending physician to further review and to correct to the appropriate level, if indicated and the attending physician concurs
• Confirms member demographics are correct with the information in the SHP computer system
  • All incorrect information will be documented in the designated area in the system and reported to the SHP Enrollment Department
• Confirms if a Plan member has a health care surrogate identified, in the event he/she is unable to make decisions for himself/herself and documents this information in the SHP system
• Begins identifying discharge planning and transition of care needs, including social needs, for the member with the initial concurrent review
  • Discharge planning and transition of care begins with the admission and should be completely in place prior to the time of discharge
  • Early identification of transition of care needs will help to ensure that the member is discharged to the appropriate level of care setting
• Participates and updates the Plan’s Medical Director, or designee, in completing regular case reviews to ensure the on‑going length of stay is appropriate and meets criteria
• Works closely with the attending physician, specialists, the facility case management/social services team, facility ancillary staff, the member and/or legal representative, and the PCP in ensuring lines of communication are open and the immediate and discharge needs of the member are being met
• Identifies, documents in the SHP computer system, any potential coordination of benefits (COB) associated with this member and the admission
• Identifies members who may benefit from care management services and makes appropriate referrals to the Care Management Team, as indicated
• Understands the SHP Care Management Model of Care and actively participates as a member of the Interdisciplinary Care Team, as needed
• Identifies and reports any potential quality or risk management issues to the appropriate Plan designated associate
• Responsible for documenting the following within the authorization in the SHP computer system:
  • Reason(s) for…