Concurrent Review RN: Care Transitions & Utilization Expert

Sky Mavis; Salem (OR); Hybrid; USD 90,000 - 100,000; Full time

Benefits offered by this job

Benefits package

Job summary

P3 Health Partners in Oregon is seeking a Concurrent Review RN to ensure appropriate utilization of healthcare resources and smooth care transitions across the continuum.

You will collaborate with hospitals, physicians, and care teams, perform reviews including prior authorizations and concurrent reviews, and apply evidence-based criteria to support medical necessity.

This hybrid role offers in-office three days per week, a $90,000–$100,000 salary and a comprehensive benefits package.

Qualifications

• Graduate of an accredited School of Nursing.
• Active RN license in Oregon with ability to obtain licensure in multiple states.
• Minimum of four (4) years of clinical nursing experience.
• Minimum of two (2) years in a managed care, Medicare Advantage, or HMO environment.
• Experience conducting medical necessity reviews and applying evidence-based clinical guidelines.

Responsibilities

• Perform telephonic and onsite utilization reviews, including prior authorization, concurrent review, and transition of care evaluations.
• Review and approve services within scope of authority and escalate as needed.
• Escalate complex cases and medical necessity questions to the Medical Director as needed.
• Apply evidence-based review criteria (Health plan benefits, CMS guidelines, LCD/NCD, InterQual/MCG).
• Utilize clinical judgment to assess medical necessity, level of care, and service utilization.
• Collaborate with hospitals, providers, and internal stakeholders to support discharge planning and transitions.
• Request and review additional clinical documentation to support decisions.
• Coordinate care with physicians, specialists, ED personnel, patients, and families.
• Educate providers and clinical staff on utilization management processes and criteria.
• Document all clinical reviews and decisions in designated systems.

Skills

Utilization management

Care coordination

Evidence-based decision making

Clinical documentation

Communication with physicians/teams

Independent work

InterQual/MCG/CMS guidelines

Microsoft Office

Medical management software

Education

Accredited School of Nursing

RN license (Oregon)

Bachelor of Science in Nursing (BSN)

Tools

EHR systems

Microsoft Office

Medical management software

Job description

P3 Health Partners in Oregon is seeking a Concurrent Review RN to ensure appropriate utilization of healthcare resources and smooth care transitions across the continuum.

You will collaborate with hospitals, physicians, and care teams, perform reviews including prior authorizations and concurrent reviews, and apply evidence-based criteria to support medical necessity.

This hybrid role offers in-office three days per week, a $90,000–$100,000 salary and a comprehensive benefits package.