Clinical Review Nurse – Concurrent Review

Job Description:

• Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care
• Review quality and continuity of care, acuity level, resource consumption, length of stay, and discharge planning
• Work with Medical Affairs and/or Medical Directors regarding member care
• Collect, document, and maintain concurrent review findings, discharge plans, and actions in health management systems
• Work with healthcare providers to approve medical determinations or provide recommendations
• Educate providers on utilization processes
• Provide leadership feedback on opportunities to improve level of care and medical necessity
• Review transfer and discharge plans to support timely transitions between levels of care and facilities
• Collaborate with care management on member referrals
• Comply with all policies and standards
• Perform other duties as assigned

Requirements:

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing
• Minimum of 5 years nursing experience
• 2–4 years of related experience
• 2+ years of acute care experience required
• LPN state licensure required
• RN state licensure and/or compact state licensure for the State of Nevada required
• Applicants must reside in the Central, Mountain, or Pacific Time Zone
• LTACH, IPR, or SNF experience
• Clinical knowledge to determine overall health, treatment needs, and appropriate level of care preferred
• Knowledge of Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred

Benefits:

• Health insurance
• 401K
• Stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules
• Additional forms of incentives may be included in total compensation