Find Your Dream Job
Finding a Dream Job can feel a lot like searching for a needle in a haystack. We start by viewing each candidate as an individual, identifying their distinct strengths and guiding them to the right opportunities. We're also big believers in mentoring our candidates and creating long-term relationships. Helping you find your Dream Job is really just the start. We want to help you build a Dream Career!
Stop Dreaming. Start Searching.
Concurrent Review Nurse 3
Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.
- Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
- Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
- Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care Conduct discharge planning
- Educate providers on utilization and medical management processes
- Provide clinical knowledge and act as a clinical resource to non-clinical team staff
- Enter and maintain pertinent clinical information in various medical management systems For New Hampshire and Massachusetts - home visits required.
- Graduate from an Accredited School of Nursing.
- Bachelor’s degree in Nursing preferred
- Current state’s LPN/LVN or RN license.
- 5-7 years of experience health plan management review/concurrent review experience
- strong computer knowledge
MUST Work Schedule: M-F 8-5pm