Concurrent Review NurseJob DescriptionThe Concurrent Review Nurse performs concurrent reviews to determine a member's overall health, evaluates medical necessity, and contributes to discharge planning according to care policies and guidelines. The role involves assisting in the evaluation of inpatient services to validate the necessity and setting of care being delivered to the member.
Need expereince in utilization review
Acute care expereince
Medicare knowledge
Compact license
Responsibilities
Perform concurrent reviews of members for appropriate care and setting to determine overall health and appropriate level of care.
Review quality and continuity of care by assessing acuity level, resource consumption, length of stay, and discharge planning of the member.
Collaborate with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered.
Collect, document, and maintain concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines.
Work with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings.
Assist with providing education to providers on utilization processes to ensure high quality appropriate care to members.
Provide feedback to leadership on opportunities to improve appropriate level of care and medical necessity based on clinical policies and guidelines.
Review members' transfer or discharge plans to ensure timely discharge between levels of care and facilities.
Essential Skills
Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing.
2-4 years of related experience.
Licensed Practical Nurse (LPN) State Licensure required.
Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care.
Knowledge of Medicare and Medicaid regulations.
Knowledge of utilization management processes.
Apply Today To Learn More!Pay and BenefitsThe pay range for this position is $30.00 - $40.00 Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)Workplace TypeThis is a fully remote position.Application DeadlineThis position will be accepting applications until Jan 27, 2025.About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
Hiring diverse talent
Maintaining an inclusive environment through persistent self-reflection
Building a culture of care, engagement, and recognition with clear outcomes
Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.