New

Clinical Review Nurse - Concurrent Review

Spectraforce Technologies

United States, California, Los Angeles

Nov 18, 2024

Title: Clinical Review Nurse - Concurrent Review

Duration: 07 Months (Potential to Extend)

Location: Remote - CA

Responsibilities: Summary: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Job Responsibilities: Perform review of concurrent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director for secondary review. Complete medical necessity and level of care reviews for requested services using InterQual guidelines and refer to Medical Directors for review depending on case findings. Collaborate with various staff within provider networks and discharge planning team electronically and telephonically to coordinate member care. Conduct discharge planning. Educate providers on utilization and medical management processes. Provide clinical knowledge and act as a clinical resource to non-clinical team staff. Enter and maintain pertinent clinical information in various medical management systems. Nurses are expected to Review an average of 20 cases/day
Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:		Preferred Skills/ Experience:
1.	Computer Skills- Microsoft, Teams, Zoom	1.	Knowledge of InterQual reviews
2.	Good communication skills for clinical rounds	2.
3.	2-4 years of hospital, managed care, UM exp	3.
Education Requirement:	Graduate from an accredited School of Nursing	Education Preferred:	ASN or BSN
Software Skills Required:	Microsoft, basic computer knowledge with electronic medical record programs
Required Certifications:	California Registered Nurse	Required Testing:	InterQual Interrater Reliability Testing