Clinical Review Nurse - Concurrent Review
New
United States, Central, Mountain, PacificFull-TimeMiddle
Salary56,201.6 - 100,984 USD per year
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Job Details
- Experience
- 2 – 4 years of related experience; 2+ years of acute care experience required
Requirements
- Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing.
- 2 – 4 years of related experience.
- 2+ years of acute care experience.
- Must have or willing to obtain an Oregon License.
- LPN or RN state licensure required.
- Knowledge of clinical documentation and treatment needs.
- Knowledge of Medicare and Medicaid regulations preferred.
- Knowledge of utilization management processes preferred.
Responsibilities
- Perform concurrent reviews for appropriate care and setting.
- Review quality and continuity of care including acuity and length of stay.
- Work with Medical Affairs and Medical Directors regarding member care.
- Collect and document concurrent review findings and discharge plans in health management systems.
- Collaborate with healthcare providers to approve or recommend medical determinations.
- Provide education to providers on utilization processes.
- Review discharge plans to ensure timely transitions between levels of care.
- Collaborate with care management on member referrals.
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