RN Inpatient Concurrent Review

Dignity Health; Rancho Cordova (CA); Remote; Full time

Job summary

A leading healthcare organization is seeking a dedicated professional for an on-call position focused on monitoring inpatient admissions and conducting concurrent reviews for medical necessity. The role requires collaboration with various healthcare teams to ensure appropriate care levels and facilitate transitions of care. Ideal candidates will have significant experience in acute care and hold a current RN license. This position offers the flexibility of remote work within driving distance to Sacramento, CA.

Qualifications

• Three years of acute care or related experience.
• Current CA RN license required.

Responsibilities

• Monitor inpatient admissions and conduct concurrent reviews.
• Coordinate with multidisciplinary teams to address patient needs.
• Perform concurrent reviews for emergent/urgent stay requests.

Skills

Collaboration

Clinical Judgment

Education

Bachelor's degree

Job description

Responsibilities

Please note: This is a non-benefitted, on-call position.

This position is work from home within driving distance to Sacramento, CA.

Position Summary:

This role involves monitoring inpatient admissions and conducting concurrent reviews for appropriate level of care and medical necessity using InterQual and Medicare criteria. The position requires close collaboration with hospitalist teams, medical directors, specialists, clinic staff, and inpatient care coordination to communicate inpatient needs, care levels, and medical necessity. It also includes coordinating post-hospitalization care and transition of care across the healthcare continuum.

Responsibilities may include:

1. Review patient records concurrently to assess needs, background history, and current care requirements.
2. Coordinate with multidisciplinary teams to address individual patient needs and resolve care variances.
3. Perform concurrent reviews for emergent/urgent and ongoing stay requests, ensuring appropriate care and admission status, and recommend approvals or escalate to physicians or medical directors.
4. Complete medical necessity and care level reviews using clinical judgment and guidelines, referring cases to Medical Directors as needed.
5. Collaborate with provider networks, hospital teams, and care coordinators to establish discharge and transition planning.
6. Identify and resolve system process issues affecting utilization management functions.
7. Assist in updating and training staff on InterQual or other screening tools.
8. Develop and maintain policies for non-coverage notifications, ensuring compliance.
9. Support patients, families, and care teams in overcoming barriers related to referrals and utilization management.
10. Lead efforts to optimize utilization management and care coordination across the care continuum, considering the served population.
11. Perform other duties as assigned.

Qualifications

Minimum Qualifications:

• Three (3) years of acute care or related experience, including case management, utilization review, or discharge planning.
• Current CA RN license.

Preferred Qualifications:

• Experience with concurrent review and prior authorizations.
• Bachelor's degree preferred.

Overview

Dignity Health Medical Foundation, established in 1993, is a nonprofit organization with care centers across California. It is affiliated with Dignity Health, one of the largest health systems in the nation, with hospitals and care centers in California, Arizona, and Nevada. The foundation collaborates with physicians and providers to deliver comprehensive healthcare services, supported by advanced technology, skilled physicians, and state-of-the-art facilities. With over 130 clinics in California, it emphasizes high-quality, patient-centric care focused on 'humankindness'.

We are committed to creating meaningful work environments where staff can excel and grow professionally through challenging assignments and collaborative relationships. Our staff is highly trained and dedicated to maintaining excellence in care and service.

One Community. One Mission. One California (https://youtu.be/RrPuiSnALJY?si=pvQgPZ6ZWZM60TPV)

Pay Range

$46.96 - $68.10 per hour

We are an equal opportunity/affirmative action employer.