Concurrent Review Nurse

Location: Fresno, CA
Date Posted: 06-29-2018
CareNational
Concurrent Review Nurse (RN or LVN) - Managed Care
Fresno, CA
 
Concurrent Review Nurse Job Summary:
  • The Concurrent Review Nurse is responsible for the timely and rapid utilization management and utilization review of emergent/urgent services provided to members, as well as continued stay requests, in order to verify medical necessity against an establish criteria .
  • The Concurrent Review Nurse will performs reviews of services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
  • Utilize clinical skills to telephonically provide and facilitate utilization review, continued stay reviews and utilization management of all cases based on clinical experience and recognized guidelines.
  • The Concurrent Review Nurse will obtain the information necessary to assess a member's clinical condition, identify ongoing clinical care needs and ensure that members receive services in the most optimal setting to effectively meet their needs.
Concurrent Review Nurse Background:
  • Current, valid, and unrestricted state Registered Nurse (R.N.) or License Vocational Nurse (L.V.N.) license.
  • CCM or CPUR or similar certification is preferred
  • 2 years acute care clinical nursing experience is required.
  • 1 year of recent experience in Utilization Review or Utilization Management at a health plan or other managed care organization (HMO/TPA/IPA/etc).
  • Knowledge of guidelines for Medicaid/Medicare and related state programs is required.
  • Experience using Milliman or InterQual criteria for medical necessity, setting and level of care, and concurrent patient management.
  • Computer skills to include Microsoft Word, Excel, database use, and basic data entry.


​#Clinical
Erik Berg
SEARCH CONSULTANT
CareNational
erik@carenational.com
443.470.8240 (CALL – TEXT – FAX)
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