Concurrent Review Registered Nurse

Healthcare Support Staffing; San Leandro (CA); On-site; USD 60,000 - 80,000; Full time

Job summary

A national healthcare staffing firm in San Leandro is seeking a professional to manage in-patient review and discharge planning. The role involves coordinating case management activities and interfacing with various medical and healthcare staff to expedite discharge processes. Candidates should have Utilization Management and Case Management experience, along with critical thinking and clinical judgment skills. This position offers valuable opportunities in healthcare coordination and management.

Qualifications

• Utilization Management and Case Management experience.
• Understanding of healthcare benefits for Medi-Cal, Medicare, and Commercial lines.
• Experience with inpatient concurrent review for complex medical patients.

Responsibilities

• Manage and coordinate post-discharge needs and case management activities.
• Interface with medical staff, HMO’s, and families to expedite discharge processes.
• Write denial letters and Notices of Action using HMO templates.

Skills

Utilization Management

Case Management

Critical Thinking

Clinical Judgment

Job description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

• Manage and coordinate in-patient review and discharge planning and case management activities related to immediate post-discharge needs.
• Train in and implement Care Transitions model in discharge planning; participate in diffusion of model in clinic setting.
• Support proactive hospital discharge planning, transfers, and redirection.
• Proactively and collaboratively, interface with medical director, HMO’s, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
• Meet departmental review and documentation standards for work assignments.
• Write denial letters, and other Notices of Action, to member/providers using HMO templates.
• Serve as a liaison between hospital, clinics, health plan, vendors, outside agencies, and providers.
• Work with health plans on special requests such as obtaining ancillary services from non-contracting providers.
• Assist UM Director in the periodic review and update of UM/Case Management policy and procedures, and in the ongoing evaluation and improvement of workflow systems for UM.
• Coordinate completion and send required UM monthly reports to Health Plans, as assigned.
• Participates in Case Management committee meetings as well as outreach activities, agency advocacy, and serves on ad hoc committees, as requested.

Qualifications

• Utilization Management and Case Management experience
• Understanding and knowledge of healthcare benefits associated with various business lines (Medi-Cal, Medicare, Commercial).
• Inpatient concurrent review, especially working with complex medical patients, including aged, blind, disabled.
• Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
• Logical, independent thinker.
• 1 year Utilization Management in hospital, HMO, or IPA setting.
• 1 year in health care delivery setting at hospital, clinic or physician’s office

Additional Information

Hours for this Position: