Job Description

Position: Concurrent Review Nurse

Location: 100% Fully Remote (Must reside and hold an active license in California)
Schedule: Monday to Friday, 8:00 AM - 5:00 PM PST

Compensation:
The hourly pay for this position ranges from $40 to $42, depending on experience.
Full-time employees are eligible for benefits after 90 days of employment, including a 401(k) with company match after one year of service.

Qualifications:

Active Registered Nurse (RN) license in California
Residency in California is required
2-4 years of experience in hospital settings, managed care, or utilization management
Familiarity with healthcare systems and managed care practices is preferred
Understanding of Medicare and Medicaid Utilization Review processes
Strong computer skills, with proficiency in Microsoft systems; experience with TruCare is a plus
Responsibilities:
As a Concurrent Review Nurse, you will play a vital role in enhancing the quality and cost-effectiveness of medical care. Your clinical expertise will guide the appropriate application of policies and guidelines during urgent and continued stay reviews.

Conduct concurrent and continued stay reviews to ensure appropriate care and setting, adhering to established guidelines and policies. Approve services or escalate requests to the Physician or Medical Director for further evaluation.
Perform medical necessity and level of care reviews for requested services using InterQual guidelines, referring to Medical Directors as needed based on case findings.
Collaborate with staff within provider networks and the discharge planning team, both electronically and via phone, to coordinate comprehensive member care.
Assist in discharge planning efforts and educate providers on utilization and medical management processes.
Serve as a clinical resource for non-clinical team members, sharing your expertise and knowledge.
Enter and maintain relevant clinical information in various medical management systems.
We look forward to welcoming a dedicated and knowledgeable nurse to our team who is passionate about improving patient care!
Employment Type: Full-Time
Salary: $ 40.00 42.00 Per Hour

Job Tags

Hourly pay, Full time, Immediate start, Monday to Friday,

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