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Clinical - Clinical Review Nurse - Concurrent Review

Remote:

Full Remote

Contract:

Fixed term

Experience:

Mid-level (2-5 years)

Work from:

Texas (USA), United States

Offer summary

Qualifications:

Registered Nurse with TX licensure, Graduate from an Accredited Nursing School, 2-4 years of related experience, BSN preferred, Documentation and computer skills.

Key responsabilities:

Perform concurrent reviews for care necessity
Evaluate member's overall health and discharge planning
Review approximately 20 cases daily
Collaborate with doctors and case managers
Ensure timely completion of tasks

Axelon Services Corporation Human Resources, Staffing & Recruiting SME https://www.axelon.com/

501 - 1000 Employees

See more Axelon Services Corporation offers

Job description

Your missions

Location: Remote - Position requires a registered nurse with TX licensure

SHIFT: Mon-Fri 8-5, will Need to work one Saturday every 2 months
No overtime required

Duration: 6+ month contract with possibility to extend

Requirement: Position requires a registered nurse with TX licensure

Job Description: Position Purpose:
Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.

Walk me through the day to day responsibilities of this the role and a description of the project:

The nurse will be reviewing about 20 cases a day to review for medical necessity on a member that admits to the hospital. Job is to advocate and protect the member from unnecessary admissions to the hospitals. Nurse has to follow many changes and processes to complete the authorizations. Will be working with a group of nurses to assist each other and collaborate on getting the cases done. The nurse will be in contact with doctors and case managers to achieve decisions and/or receive more information about the member’s condition/status. Nurse will be using multiple resources we have to achieve successful completion of the cases.

Describe the performance expectations/metrics for this individual and their team:

About 20 cases a day need to be done daily. Have to be timely every day. Clearly communicate with leader if unable to come in for work or coming in late.

Education/Experience:
Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.

Required Skills/Experience:			Preferred Skills/ Experience:
1.	TX RN license or compact state license		1.	UM
2.	Communication skills		2.	Clinical/managed care experience
3.	Documentation/Computer skills		3.
Education Requirement:		RN	Education Preferred:		BSN
Software Skills Required:		Microsoft, multitasking
Required Certifications:		TX RN license or compact state license	Required Testing: