Judge Healthcare is currently seeking a Concurrent Review Nurse- RN in Rancho Cucamonga, CA!
Under the direction of the Inpatient Review Nurse Manager and Supervisor, the incumbent will work with hospitals and IPAs, in collaboration with their assigned Team Center, that may include an Discharge Planner and Inpatient Coordinator, to initiate coordinated and continuous cost effective quality healthcare to ensure the continuity of the Member’s care needs are met timely and readmission prevention is anticipated This job will have the following responsibilities:
Qualifications & Requirements:
- Responsible for the oversight of concurrent and retrospective reviews for medical necessity per evidenced based criteria, appropriateness of service and level of care, either through telephonic review, clinical documentation submitted by respective facilities and/or electronic medical records (EMR) access.
- Responsible for conducting reviews to ensure that Member’s treatment plan is consistent with diagnosis(es), specifically initial review within 24 hours to ensure Member’s meet specified criteria for the respective admission.
- Responsible for working in collaboration with the Discharge Planner and Inpatient Coordinator to ensure timely arrangements for transitions to higher or lower level of care and assist with transfer orders as needed.
- Possession of a valid RN license issued by the State of California.
- Experience:Two or more years of utilization management/case management in a health care delivery setting, with an emphasis on Concurrent Review and utilization management.
Explanation Of Benefits (Eob)
Based on Job Title, Location and Skills
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