Address: Dallas, , TX 75201
Telephone: 901-207-8038
Email Address: smithassociates1725@gmail.com
Hours: Office Hours – 3:30 PM – 8:00 PM CST
This is a fast-paced role. The nurse will be reviewing clinical faxes in by facilities for medical necessity. The nurse gains valuable medical insurance. 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.
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Position Title : Clinical Review Nurse – Concurrent Review
ATTENTION : ” $TOP PAY “( Interviewing Now )
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Location : Dallas, TX
Salary : Competitive
Full time : RN Nurse Manager ICU
– All On-site
Location: 100% Remote – TX: RN only with TX license
SHIFT: Tuesday – Saturday 8am-5pm CST- schedule is firm- no flexibility
Duration: 6 months, contract to hire.
Summary :
– This is a fast-paced role.
– The nurse will be reviewing clinical faxes in by facilities for medical necessity.
– The nurse gains valuable medical insurance.
– 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.
Typical Day in the Role:
– 8am-5pm CST, Tues – Saturday.
– Will have a task queue to work from.
– Will work closely with team lead and team members to meet daily deadlines.
– Will be reviewing cases for medical necessity all day.
– Will work from home with multiple monitors and needs to be able to multitask.
– Once off training, they will need to work one Saturday every other month.
– 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 members.
– 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.
Candidate Requirements :
Education/Certification Required: Graduate from an Accredited School of
Nursing or bachelor’s degree in nursing
Preferred: 2 – 4 years of related experience- 4 years is preferred
Licensure Required: Texas RN
Preferred:
Years of experience required: UM experience preferred not required
Disqualifiers : Less than 2 years of nursing experience, no LPNs
Additional qualities to look for: Multitasking, fast learner, positive, and being
computer savvy.
For consideration you must act now, send resume to
smithassociates1725@gmail.com. Sincerely,
Gerald Smith
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