Concurrent Review Nurse - Acute Care RN (Onsite Louisville)

Pyramid Consulting Healthcare; Louisville (KY); On-site; USD 50,000 - 54,000; Full time

Benefits offered by this job

Health insurance (medical, dental, and

401(k) plan

Paid sick leave

Job summary

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.

Qualifications

• 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.

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.

Skills

Acute care experience

RN License

Education

RN License

Job description

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.