New

Clinical Review Nurse - Concurrent Review

Spectraforce Technologies

United States, Missouri, Kansas City

Nov 25, 2024

Job Title: Clinical Review Nurse - Concurrent Review

Job Location: Remote

Job Duration: 4 Months (Potential to extend)

Responsibilities: Responsible for managing facilities for acute care in patient stays. Initial reviews, concurrent stay review & discharges (beginning, middle & end) Being a team player - lots of collaboration Role is independent but the team works together on many items. Being able to prioritize tasks. Productivity metrics - how many authorizations they complete per day. Weighted productivity - credit is given for certain tasks (sending out a denial letter, building an authorization, gathering additional details & information) Team does complete audits - may be more relevant when they are converted (meeting criteria, completing authorizations appropriately) High pressure turn around times (sometimes they must be able to complete an authorization within 24 hours)
Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:		Preferred Skills/ Experience:
1.	acute care experience (ICU, med surg) and compact license.	1.	Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred.
2.	UM experience - not a dealbreaker, is teachable	2.	Knowledge of Medicare and Medicaid regulations preferred.
3.	Multitasking, organization, fast paced	3.	Knowledge of utilization management processes preferred.
Education Requirement:	Requires Graduate from an Accredited School of Nursing or bachelor's degree in nursing and 2 - 4 years of related experience.	Education Preferred:
Software Skills Required:	TruCare, Interqual (Preferred) - Microsoft Office Platform - EXCEL is helpful as the team does use for daily reporting (general understanding) typing skills