Concurrent Review RN

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!

Day to Day Duties:

• This person will be reviewing charts to ensure members are receiving the most appropriate/cost effective care. They will be reviewing the progress of discharge planning to make sure they take appropriate action to keep members out of the hospital. This will be 100% onsite (no travel).
• Company
  
  Job Description:
  
  Position
  
  Purpose:
  
  Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.
• Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
• Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
• Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care
• Educate providers on utilization and medical management processes
• Provide clinical knowledge and act as a clinical resource to non-clinical team staff
• Enter and maintain pertinent clinical information in various medical management systems
• Direct care to participating network providers
• Participate in utilization management committees and work on special projects related to utilization management as needed
• Serve as a subject matter expert for questions or issues for other Concurrent Review Nurses and Prior Authorization Nurses
• Audit case reviews to ensure compliance with utilization management policies and procedures
• Assist with the development of utilization management workflows, policies, and procedures

Minimum Education /Licensures/

Qualifications:

• RN licensure
• 3+ years of UM experience in a managed care setting (this is a must)
• 2+ years of clinical nursing experience

Shift:

• 8:00-5:00 100% office Based

Interested in being considered?

If you are interested in being considered for this position, please click the apply button below. Or call Ashley Greene  ext 169