Remote Concurrent Review Nurse

A-Line Staffing Solutions

El Paso Texas

United States

Healthcare - Nursing
(No Timezone Provided)

Now hiring for a Top Healthcare / Managed Care company located near El Paso, TX (working remote) whom are in need of an experienced Concurrent Review Nurse to become a part of the team, for an remote/work from home position to start but will return to in office once safe to return.

  • Position will be remote or work from home - Most Live near El Paso, TX

Pay/Hours:

  • Pay Rate: $35.00 to $37.00 per hour (possible pay increase after 90 days)
  • Hours: Full time Monday - Friday 40 hour 8:00 a.m. - 5:30 p.m.

Job Description:.

  • Reviewing clinical charts for medical necessity (start them slowly, goal is between 8 to 12 charts/day)
  • Responsible for interdisciplinary rounds, discharge needs
  • Telephonic review of emergent/urgent, and continued stay requests for the appropriate level of care and setting following medical necessity guidelines, UM policy and procedures.
  • RN with previous hospital UM or NICU experience. Previous employment with a managed care company. Experience with electronic medical record systems and computer documentation. Time management and good communication skills.
  • Perform 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
  • Conduct discharge planning
  • 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 system

Requirements:

  • Education/Experience: Graduate from an Accredited School of Nursing.
  • Bachelors degree in Nursing preferred.
  • Knowledge of healthcare and managed care preferred
  • .Licenses/Certifications: RN license..0-2 years of experience

Why Apply: Company Benefits!

  • Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
  • 401k after 1 year of employment: With employer match and profit sharing
  • GREAT Hours! Full-Time Monday through Friday, 40 hours per week Overtime available paying time and a half over 40 hours worked.
  • Competitive Pay Rate! With possible pay increases after 90 days of employment.
  • Work Life Balance! Growth Potential

Managed Care, Health Plan, Health Insurance, Case Manager, Care Manager, Utilization Review, Utilization Management, STARS, HEDIS, Complex Case Management, CCM, Certified Case Manager, NCQA, URAC, CMS, Medicare, Medicaid, HMO, RN, BSN, MSN, Registered Nurse, Quality Assurance, Quality Improvement


Associated topics: bsn, domiciliary, intensive, intensive care unit, neonatal, staff nurse, surgical, tcu, transitional, unit

Remote Concurrent Review Nurse

A-Line Staffing Solutions

El Paso Texas

United States

Healthcare - Nursing

(No Timezone Provided)

Now hiring for a Top Healthcare / Managed Care company located near El Paso, TX (working remote) whom are in need of an experienced Concurrent Review Nurse to become a part of the team, for an remote/work from home position to start but will return to in office once safe to return.

  • Position will be remote or work from home - Most Live near El Paso, TX

Pay/Hours:

  • Pay Rate: $35.00 to $37.00 per hour (possible pay increase after 90 days)
  • Hours: Full time Monday - Friday 40 hour 8:00 a.m. - 5:30 p.m.

Job Description:.

  • Reviewing clinical charts for medical necessity (start them slowly, goal is between 8 to 12 charts/day)
  • Responsible for interdisciplinary rounds, discharge needs
  • Telephonic review of emergent/urgent, and continued stay requests for the appropriate level of care and setting following medical necessity guidelines, UM policy and procedures.
  • RN with previous hospital UM or NICU experience. Previous employment with a managed care company. Experience with electronic medical record systems and computer documentation. Time management and good communication skills.
  • Perform 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
  • Conduct discharge planning
  • 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 system

Requirements:

  • Education/Experience: Graduate from an Accredited School of Nursing.
  • Bachelors degree in Nursing preferred.
  • Knowledge of healthcare and managed care preferred
  • .Licenses/Certifications: RN license..0-2 years of experience

Why Apply: Company Benefits!

  • Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
  • 401k after 1 year of employment: With employer match and profit sharing
  • GREAT Hours! Full-Time Monday through Friday, 40 hours per week Overtime available paying time and a half over 40 hours worked.
  • Competitive Pay Rate! With possible pay increases after 90 days of employment.
  • Work Life Balance! Growth Potential

Managed Care, Health Plan, Health Insurance, Case Manager, Care Manager, Utilization Review, Utilization Management, STARS, HEDIS, Complex Case Management, CCM, Certified Case Manager, NCQA, URAC, CMS, Medicare, Medicaid, HMO, RN, BSN, MSN, Registered Nurse, Quality Assurance, Quality Improvement


Associated topics: bsn, domiciliary, intensive, intensive care unit, neonatal, staff nurse, surgical, tcu, transitional, unit