Clinical Review Nurse - Concurrent Review

Position Title: Clinical Review Nurse - Concurrent Review

Work Location: Remote, Ohio, have to have Ohio RN license

Assignment Duration: 6 months

Position Summary:

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  The purpose of this team is to review inpatient hospital requests for inpatient level of care.

  
  
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  We work in coordination with care management on discharge planning.

  
  
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  We are placing this request for staff for a nurse who is on leave.

  
  
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  This is a temp to a possible perm position.

  
  
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  We have a three-day turn-round time for our determinations; we need an extra staff member to assist to make sure we meet our requirements.

  
  
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  Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care

  
  
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  Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member

  
  
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  Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered

  
  
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  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

  
  
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  Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings

  
  
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  Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members

  
  
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  Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines

  
  
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  Reviews member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities

  
  

Qualification & Experience:

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  Education/Certification Required: Associates

  
  
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  Preferred: Bachelors

  
  
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  Licensure Required: Ohio LPN

  
  
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  Preferred: RN

  
  
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  Must haves: Inpatient hospital experience, preferably UM review experience. Computer skills.

  
  
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  Nice to haves: Experience in Microsoft teams, outlook, and excel.

  
  
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  Disqualifiers:

  
  
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  Performance indicators: 1.2 reviews per hour minimum.

  
  
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  Top 3 must-have hard skills

  
  
  
  
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    Inpatient Hospital experience

    
    
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    UM Concurrent Review

    
    
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    Ability to work in a remote environment

    
    
    
    
    
    
    

    Candidate Requirements
    Education/Certification	Required: Associates	Preferred: Bachelors
    Licensure	Required: Ohio LPN	Preferred: RN
    Years of experience required Disqualifiers Best vs. average Performance indicators	Must haves: Inpatient hospital experience, preferably UM review experience. Computer skills. Nice to haves: Experience in Microsoft teams, outlook, and excel. Disqualifiers: Performance indicators: 1.2 reviews per hour minimum.
    Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection	1	Inpatient Hospital experience
    2	UM Concurrent Review
    3	Ability to work in a remote environment