Clinical - Concurrent Review Nurse 1

MWIDM; United States; Remote; USD 50,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated clinical professional to enhance the quality of medical care through effective utilization management. In this exciting remote role, you will apply your clinical acumen to review emergent and continued stay requests, ensuring that patients receive appropriate care based on established guidelines. You'll work closely with various teams to coordinate care and educate providers on medical management processes. This position offers a unique opportunity to make a significant impact in the healthcare sector while working from the comfort of your home. If you're passionate about improving patient outcomes and have a nursing background, this role is perfect for you.

Qualifications

• Graduate from an accredited nursing school with a current nursing license.
• 0-2 years of experience in a clinical setting.

Responsibilities

• Promote quality and cost-effectiveness of medical care through clinical reviews.
• Collaborate with staff to coordinate member care and conduct discharge planning.

Skills

Clinical Judgment

Collaboration

Discharge Planning

Utilization Management

Education

Graduate from an Accredited School of Nursing

Bachelor’s degree in Nursing

Current state’s LPN/LVN or RN license

Tools

Medical Management Systems

Job description

Remote Job - United States | Posted - 01/10/23

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Overview

• Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.
• 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.
• For New Hampshire and Massachusetts - home visits required.

Minimum Requirements

• Education/Experience: Graduate from an Accredited School of Nursing.
• Bachelor’s degree in Nursing preferred.
• Current state’s LPN/LVN or RN license.
• 0-2 years of experience.

About the Company

MWIDM Inc. is a WMBE Certified global staffing firm serving Fortune 2000 clients with customized and scalable workforce solutions. With our account management integrated into our delivery process, we provide you with staffing solutions that are transparent and robust irrespective of the industry you function.