Remote Clinical Review Nurse - Utilization & Discharge

Pyramid Consulting; United States; À distance; USD 48 000 - 54 000; Plein temps

Avantages offerts par ce poste

Health insurance

401(k)

Paid sick leave

Résumé du poste

Pyramid Consulting is seeking a Clinical Review Nurse for a 06+ month remote contract in the United States. The role focuses on concurrent reviews to assess health status and appropriate levels of care, with collaboration across Medical Affairs and discharge planning.

Requirements include an accredited nursing program, RN licensure, and 2–4 years in acute care with utilization management experience preferred. Benefits include comprehensive health coverage and time-off per location.

Qualifications

• Active RN license with nursing degree from an accredited program.
• Experience in acute care and utilization management preferred.
• Familiar with Medicare/Medicaid regulations optional.

Responsabilités

• Perform concurrent reviews to determine health status and care level.
• Assess acuity, resources, length of stay, and discharge planning.
• Discuss member care with Medical Affairs/Directors.
• Document findings and discharge plans in health systems.
• Collaborate with providers to authorize determinations.
• Educate providers on utilization processes for quality care.
• Provide leadership feedback to improve care and necessity.
• Review transfer/discharge plans to facilitate timely discharges.
• Collaborate with care management for referrals.
• Maintain productivity targets and audit scores.

Connaissances

Acute care nursing

Utilization management

Clinical documentation

Collaboration with medical staff

Formation

Bachelor’s degree in Nursing

RN licensure

Outils

Health management systems

Description du poste

Pyramid Consulting is seeking a Clinical Review Nurse for a 06+ month remote contract in the United States. The role focuses on concurrent reviews to assess health status and appropriate levels of care, with collaboration across Medical Affairs and discharge planning.

Requirements include an accredited nursing program, RN licensure, and 2–4 years in acute care with utilization management experience preferred. Benefits include comprehensive health coverage and time-off per location.