Overview
Remote
On-site
Compensation
$35-$45/hour
Job Description
Position Title: Clinical Review Nurse -Concurrent Review
Location: Remote, Compact Nursing License Required, Central Time Zone
Duration: 12 Months
Schedule: Friday-Tues, 2 pm-10 pm CST, 40 hours/week.
So, either five 8-hour shifts until 10 PM EST, Friday-Tues, OR four 10-hour shifts until 10 pm EST, Sat-Tues
PR: $35-45.00/HR
Key Responsibilities
- Performs concurrent reviews of members 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
Education/Certification Required:
Requires graduated from an accredited school of nursing or Bachelor's degree in nursing
Licensure Required:
Compact Nursing License-RN, LPN, LVN.
Years of experience required:
- 1+ years
Disqualifiers:
- Inability to work possible weekend hours and holidays on a rotation basis as applicable or needed by business needs
Additional qualities to look for:
- MCO experience, specifically with Medicaid, True Care Cloud experience is a bonus, experience working remote
Skills:
- Ability to complete work independently and with minimal supervision after training.
- Team player
- Great organizational skills
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FAQs About Clinical Review Nurse -Concurrent Review Jobs at Pacer Group
What is the work location for this position at Pacer Group?
This job at Pacer Group is located in stebbins, AK, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at Pacer Group?
Candidates can expect a pay range of $35–$45 per hour for this role.
What employment applies to this position at Pacer Group?
The employer has not provided this information. This may be discussed during the hiring process.
What is the process to apply for this position at Pacer Group?
You can apply for this role at Pacer Group either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.