Concurrent Review​/Transition of Care Nurse, RN

Concurrent Review/Transition of Care Nurse, RN - 25-211

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Job Description:

Manages inpatient and outpatient utilization to assure that medical care is appropriate, efficient, and medically necessary.

• Conduct concurrent and retrospective review of inpatient and outpatient utilization according to approved criteria.
• Support proactive discharge planning, transfers, and redirection.
• Identify barriers to efficient utilization and facilitate resolution.
• Reduce avoidable bed day use by applying applicable criteria and properly documenting decisions.
• Proactively and collaboratively interface with HMOs, physicians, and members and their families to assist in expediting appropriate discharge.
• Refer members to various other departments for follow-up (i.e., Case Management, Disease Management, TPL, COB).
• Utilize department standards for authorization turnaround time.
• Issue denial letters in accordance with policy.
• Support Medical Management Team authorizations, clinical initiatives, and other responsibilities.
• Participate in the 24‑hour on‑call access program.
• Perform other duties as assigned.

• Minimum three years' clinical nursing experience.
• Excellent organizational and communication skills and ability to meet time frames.
• Ability to work effectively with a variety of customers including physicians, office staff, and members.
• Ability to work independently and make appropriate decisions.
• Computer skills.
• Managed‑care experience and certification preferred.

• Active, unrestricted, California Nursing License. Registered or Licensed Vocational Nurse.

Salary: $110,000 - $125,000 Annual

Hill Physicians is an Equal Opportunity Employer

Mid‑Senior level

Full‑time

Other – Hospitals and Health Care