Clinical - Clinical Review Nurse - Concurrent Review

Pyramid Consulting Healthcare; Louisville (KY); Presencial; USD 50.000 - 54.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance (medical, dental, and

401(k) plan

Paid sick leave

Descripción de la vacante

Pyramid Consulting Healthcare is seeking a Clinical - Clinical Review Nurse - Concurrent Review for an onsite Louisville, KY assignment.

This 6+ month contract offers competitive hourly pay and long-term potential. You will perform concurrent reviews, evaluate care quality, collaborate with Medical Affairs, document findings, and educate providers on utilization processes to ensure appropriate care levels.

Formación

• RN License required.
• 2+ years of acute care experience required.
• Clinical knowledge to assess overall health and treatment needs preferred.
• Knowledge of Medicare and Medicaid regulations preferred.
• Familiarity with utilization management processes preferred.

Responsabilidades

• Perform concurrent reviews of members to determine appropriate care and setting.
• Evaluate quality and continuity of care by analyzing acuity levels, resource consumption, length of stay, and discharge planning.
• Collaborate with Medical Affairs and/or Medical Directors regarding member care.
• Document and maintain concurrent review findings and discharge plans in health management systems.
• Work with healthcare providers to approve medical determinations based on concurrent review findings.
• Educate providers on utilization processes to ensure high-quality care.
• Provide feedback to leadership on opportunities for improvement in care levels and medical necessity.
• Review transfer or discharge plans to ensure timely transitions between care levels.
• Collaborate with care management on member referrals as appropriate.
• Comply with all policies and standards.

Conocimientos

Acute care experience

RN License

Educación

RN License

Descripción del empleo

Immediate need for a talented Clinical - Clinical Review Nurse - Concurrent Review. This is a 06+ Months Contract opportunity with long-term potential and is located in Louisville, KY (Onsite).

Job ID:26-33643

Pay Range: $36 - $39/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Perform concurrent reviews of members to determine appropriate care and setting.
• Evaluate quality and continuity of care by analyzing acuity levels, resource consumption, length of stay, and discharge planning.
• Collaborate with Medical Affairs and/or Medical Directors regarding member care.
• Document and maintain concurrent review findings and discharge plans in health management systems.
• Work with healthcare providers to approve medical determinations based on concurrent review findings.
• Educate providers on utilization processes to ensure high-quality care.
• Provide feedback to leadership on opportunities for improvement in care levels and medical necessity.
• Review transfer or discharge plans to ensure timely transitions between care levels.
• Collaborate with care management on member referrals as appropriate.
• Comply with all policies and standards.

Key Requirements and Technology Experience:

• RN License - Required
• 2+ years of acute care experience required.
• Clinical knowledge to assess overall health and treatment needs preferred.
• Knowledge of Medicare and Medicaid regulations preferred.
• Familiarity with utilization management processes preferred.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.