Field IP Concurrent Review Nurse

Healthcare Support Staffing; Coral Gables (FL); On-site; USD 35,817 - 45,460; Full time

Benefits offered by this job

Competitive salary

Excellent Medical benefits

401k

PTO

Job summary

A leading healthcare recruitment firm is looking for a professional to fill a role focused on patient admissions and discharge management in Coral Gables, Florida. The ideal candidate must have active licensure in Florida, with at least 2 years of concurrent review and managed care experience. Responsibilities include conducting assessments, ensuring proper documentation in the SHP system, and participating in case reviews. This position offers a competitive hourly salary between $26.00 and $33.00, along with excellent medical benefits and a regular Mon-Fri work schedule.

Responsibilities

• Identify admissions and discharges using various processes.
• Initiate concurrent review assessment within one working day.
• Confirm member demographics and update the SHP system.
• Participate in regular case reviews and ensure communication.
• Document care plans accurately within the SHP system.

Skills

Current, active licensure to practice within the State of Florida

Concurrent review experience

Managed Care experience

Experience with Medicaid and Medicare

Practice experience in ambulatory and hospital care

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

Responsibilities will include, but are not limited to:

• Identifying inpatient, observation, acute rehabilitation, skilled nursing facility and custodial admissions and discharges by utilizing the following processes:
  • The Plan’s daily census
  • The hospital’s individual Plan admission log (if available)
  • Inquiring Plan admissions/discharges through the admission/ER department offices
  • Direct notification by the member’s PCP or family member
  • Contacting the Plan’s hospitalist program, if available
• Initiates a concurrent review assessment within one working day of admission notification to determine initial and continued length of stay
• Identifies admissions that do not meet the requested level of care (i.e., full admission vs. observation for a hospital facility, inappropriate skill level for a SNF, etc.) and contacts the attending physician to further review and to correct to the appropriate level, if indicated and the attending physician concurs
• Confirms member demographics are correct with the information in the SHP computer system
  • All incorrect information will be documented in the designated area in the system and reported to the SHP Enrollment Department
• Confirms if a Plan member has a health care surrogate identified, in the event he/she is unable to make decisions for himself/herself and documents this information in the SHP system
• Begins identifying discharge planning and transition of care needs, including social needs, for the member with the initial concurrent review
  • Discharge planning and transition of care begins with the admission and should be completely in place prior to the time of discharge
  • Early identification of transition of care needs will help to ensure that the member is discharged to the appropriate level of care setting
• Participates and updates the Plan’s Medical Director, or designee, in completing regular case reviews to ensure the on‑going length of stay is appropriate and meets criteria
• Works closely with the attending physician, specialists, the facility case management/social services team, facility ancillary staff, the member and/or legal representative, and the PCP in ensuring lines of communication are open and the immediate and discharge needs of the member are being met
• Identifies, documents in the SHP computer system, any potential coordination of benefits (COB) associated with this member and the admission
• Identifies members who may benefit from care management services and makes appropriate referrals to the Care Management Team, as indicated
• Understands the SHP Care Management Model of Care and actively participates as a member of the Interdisciplinary Care Team, as needed
• Identifies and reports any potential quality or risk management issues to the appropriate Plan designated associate
• Responsible for documenting the following within the authorization in the SHP computer system:
  • Reason(s) for admission (chief complaint/problem)
  • Pertinent medical history, if available
  • Prior physical status, if available
  • Co‑morbidities, if available
  • Significant examination, laboratory, and radiological findings
  • All major procedures that have been completed or ordered, with findings, if available
  • Initial plan of care, including any discharge planning/transition of care needs identified and any identified potential barriers (i.e., member is in a coma and has no legal health care surrogate)
  • All communication with the attending physician, consultants and ancillary staff
  • Appropriate level of care for the admission meets criteria (i.e., full admission vs. observation status, skilled level of care, etc.) and if criteria is not met, interventions completed to correct to the appropriate status
  • Approval/denial status and length of stay approved (NOTE: If denied, all required regulatory and Plan P&P’s must be followed)
  • Significant changes in the member’s physical and/or mental status
  • Significant examination, laboratory or radiological findings
  • Major procedures that have been completed or ordered, with findings, if available
  • All communication with the attending physician, consultants and ancillary staff
  • Updated plan of care
  • Newly identified discharge planning or transition of care needs, including any identified potential barriers
  • Approved continued length of stay
  • Upon discharge, the following documentation should be included:
    • The member’s physical and mental status upon discharge
    • Any identified physical problems that occurred while in the facility (i.e., ulcerations, falls/fractures, etc.)
    • The discharge plan, which should include, but not limited to:
      • Discharge disposition (i.e., home, home with HHC, SNF, Acute Rehabilitation Facility, etc.) and the name/address of the facility
      • If discharged home, confirmation of the address and phone number that the member or legal guardian can be reached at
      • If discharged home with services, documentation of the services (i.e., Nursing, PT, OT, ST, DME) and be specific
      • Documentation that Plan discharge information was provided to the member or legal guardian
      • All other significant medical information
    • All appropriate diagnoses and procedure codes, including ICD‑9 and CPT, must be initially entered and updated, as indicated
    • NOTE: For DRG admissions, ICD‑9CM coding must be used with ongoing updating of the DRG
    • All codes/DRG updates must be confirmed prior to closing a case

Qualifications

• Current, active licensure to practice within the State of Florida
• Concurrent review experience – 2 year minimum experience
• Managed Care experience – 1‑2 year minimum experience
• Experience with Medicaid and Medicare
• Practice experience in the areas of ambulatory and hospital care

Additional Information

Hours for this Position:

Mon‑Fri 8am‑5pm

Advantages of this Opportunity:

• Competitive salary $26.00 - $33.00 per hr.
• Excellent Medical benefits Offered, Medical, Dental, Vision, 401k, and PTO