Concurrent Review RN

Daily Responsibilities:

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

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 systems

Requirements:

RN license & associate’s degree in Nursing

Must have discharge planning experience

Must have inpatient hospital experience (MED-SURG is ideal) – at least about 2 years

Computer skills! Must be comfortable & able to learn computer systems

Preferably have:

Interqual or Milliman experience

Utilization review experience

Case Management experience

Hours for this Position:

Flexible - roughly 8:00-5:00 or 8:30 to 5:00

Advantages of this Opportunity:

Competitive salary, negotiable based on relevant experience

Benefits offered, Medical, Dental, and Vision

Fun and positive work environment

Want More Information?

• If you are interested in applying to this position, please contact Ashley Greene @ 407-478-0332 ext 169 or email and click the Green "I’m Interested" Button to email your resume.