Clinical Review Nurse (RN) – Concurrent Review

Pyramid Consulting, Inc - Dallas, TX

Job Title: Clinical Review Nurse (RN) – Concurrent Review

Position: Concurrent Review

Job Type: Contract

Pay: $34 - $40/hour

Shift:

Work Type: Remote

Location

Address:

City: Dallas

State: TX

ZIP Code:

Job Responsibilities

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.
Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care.
Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member.
Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered.
Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines.
Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings.
Assists with providing education to providers on utilization processes to ensure high-quality appropriate care to members.
Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines.
Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities.
Collaborates with care management on referral of members as appropriate.
Performs other duties as assigned, complies with all policies and standards.

Required Skills

Core Skills

RN License
Concurrent Review
ADN or BSN
Communication skills
Documentation/Computer skills

Preferred Skills

Utilization Management (UM)
Clinical/Managed Care Experience

Requirements

Experience: 2-4 years of hospital experience, including 2+ years of acute care experience required

Education: Graduate from an Accredited School of Nursing or bachelor’s degree in Nursing

License & Certification:

TX RN license or compact state license

Schedule:

COVID-19 Requirements: Not Specified

Benefits

Health insurance (medical, dental, vision)
401(k) plan
Paid sick leave (depending on work location)

Supplemental Pay

Not specified

Special Notes

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type.