Concurrent Review RN

Healthcare Support Staffing; Town of Florida (NY); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare staffing firm is seeking a qualified clinical nurse for a utilization management role. Candidates should possess at least 2 years of clinical nursing experience and a year in utilization management within a managed care environment. The position requires collaboration with various healthcare staff to ensure quality care and involves reviewing medical necessity. Applicants can reach out to the recruitment consultant for further details and to apply for the position.

Qualifications

• Must have 2+ years of clinical nursing experience in an acute care setting.
• 1+ years of utilization management experience is required.
• Strong knowledge of utilization management principles is essential.

Responsibilities

• Perform onsite review of emergent/urgent care requests.
• Collaborate with provider networks to coordinate member care.
• Educate providers on medical management processes.

Skills

2+ years of clinical nursing experience in an acute care setting

1+ years of utilization management experience in a managed care setting

Knowledge of utilization management principles

Experience with medical decision support tools

Education

RN, BSN preferred

Job description

Job Description

Position Purpose: 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
• 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
• Direct care to participating network providers
• Participate in utilization management committees and work on special projects related to utilization management as needed

Qualifications

• RN, BSN preferred.
• 2+ years of clinical nursing experience in an acute care setting
• 1+ years of utilization management experience in a managed care setting. To start with this is a must!
• Knowledge of utilization management principles and healthcare managed care.
• Experience with medical decision support tools (i.e. Interqual, NCCN or Miliman) and government sponsored managed care programs strong preferred but not a must

Shift: 8-5

Additional Information

Interested in being considered?

If you are interested in applying to this position, please contact Ashley Greene at 407-478-0332 ext 169

and click the Green I’m Interested Button to email your resume.