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Concurrent Review (Registered Nurse, RN) - Health Plan
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Job Description

Concurrent Review - RN Case Manager - 40 Hours Per Week - LVNs considered

About the Job:

  1. Responsible for the assessment, facilitation, planning and coordination of medical care and services for patients to ensure appropriate treatment in the most cost effective manner
  2. Level of Care, Length of Stay, Continued Stay Reviews
  3. Coordinating discharge planning with physicians, nursing, and social services, patient and family.
  4. Review patient procedures and DRG status against criteria for Medicare, Medi-Cal, and other insurance coverage.
  5. Perform chart reviews and quality assessments using severity of illness (SI) and intensity of service (IS) InterQual criteria (and/or Milliman)
  6. Process TARS as needed

Job Requirements

Knowledge of:

  • DRG and ICD-9 and CPT coding, requirements for prior approval.
  • Available community resources.
  • Local Referral Network
  • Effective charting practices and guidelines.
  • Reimbursement related to Medicare, Medi-Cal & Managed Care
  • California Nursing License (RN) or LVN


About the Agency:

Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information!

Job Snapshot

Employment Type Full-Time
Job Type Health Care, Nurse, Insurance
Education 2 Year Degree
Experience At least 2 year(s)
Manages Others No
Industry Managed Care, Healthcare - Health Services, Insurance
Required Travel Not Specified
Job ID 24A*
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Concurrent Review (Registered Nurse, RN) - Health Plan


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