Nurse RN 3

SPECTRAFORCE; Rancho Cordova (CA); Remote; USD 80,000 - 105,000; Full time

Job summary

A leading staffing and recruiting company is seeking a Nurse RN 3 for concurrent reviews of inpatient admissions. Candidates should possess an AS Degree in Nursing, with a BSN preferred, and hold an active unrestricted RN license in California. The role, which offers remote working options, involves critical communication and documentation responsibilities, aiming to expedite care for members with urgent needs.

Qualifications

• Minimum 3-5 years of Acute Care Experience is required.
• Active unrestricted California Registered Nurse license is mandatory.
• Varied clinical background preferred.

Responsibilities

• Ensure diagnosis matches ICD 10 codes.
• Communicate determinations, ensuring compliance.
• Develop documentation reflecting determinations.

Skills

Acute Care Experience

Computer Skills

Communication Skills

Education

AS Degree in Nursing

BSN preferred

Tools

Windows-based programs

Microsoft Office

Outlook

Job description

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Day To Day Responsibilities

Performs concurrent reviews for inpatient admissions for members using FEP and evidenced-based guidelines, policies, and nationally recognized clinical criteria across FEP’s line of business. Ensures diagnosis matches ICD 10 codes.

Nurse RN 3 (Concurrent Review Nurse)

Remote | Duration: 6+ months

Responsibilities include:

• Triaging and prioritizing cases to meet required, regulatory turn-around times. Expedites access to appropriate care for members with urgent needs using expedited review processes.
• Developing determination recommendations. If the recommendation is to deny treatment, presents cases to Medical Director as required.
• Communicating determinations to providers and/or members to ensure compliance with state, federal, and accreditation requirements.
• Developing and reviewing member-centered documentation reflecting determinations in compliance with standards.
• Identifying potential quality of care issues, delays, and intervening as clinically appropriate.
• Identifying potential Third Party Liability and Coordination of Benefits cases and notifying internal departments.
• Providing referrals to Case Management, Disease Management.

Required Skills (top 3 non-negotiables)

• Minimum 3-5 years Acute Care Experience
• Strong computer skills related to Windows-based programs and applications
• Good communication skills

Preferred Skills

Varied clinical background.

Disqualifiers / Dislikes on Resumes

Previous experience in prior authorization or utilization management preferred. Must be a registered Nurse in California with an active unrestricted license. Big gaps in employment and residing in California may disqualify applicants.

Education Requirements

AS Degree in Nursing; BSN preferred.

Software Skills

Proficient with Windows-based programs, Outlook, Microsoft Office; able to navigate multiple windows and screens.

Required Certifications

Active unrestricted California Registered Nurse license.

Additional Information

Employment type: Full-time. Seniority level: Mid-Senior level. Industry: Staffing and Recruiting.