New

Clinical Review Nurse - Concurrent Review

United States, North Carolina, Raleigh

500 West Peace Street (Show on map)

Jan 29, 2025

Job Title: Clinical Review Nurse - Concurrent Review

Job Location: Remote, prefer CST zone, KS RN license required

Job Duration: 6 Months

Our team manages an assignment of inpatient facilities- when our members admit to the assigned facility; the nurse is responsible for gathering and reviewing clinical information for medical necessity.After medical necessity is determined either by criteria or secondary review; the nurse then determines the authorization and provides notification to the member and facility. We monitor authorizations for discharges and work alongside our case managers to ensure safe and appropriate discharge. Our nurses also participate in weekly complex case rounds where complex members are presented to our medical directors and case managers to allow for early and consistent collaboration to ensure timely discharge to the next level of care.
Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:		Preferred Skills/ Experience:
1.	2 years bedside nursing related to med/surg, ER, ICU, or Stepdown	1.	Utilization Management
2.		2.
3.		3.
Education Requirement:	Nursing Degree- RN or higher	Education Preferred:
Software Skills Required:	Time management, self-starter, strong communication skills, organization, adaptability, attention to detail, strong work ethic, critical thinking
Required Certifications:	Nursing License- KS	Required Testing: