Concurrent Review Nurse 1

Camp Hill, PA 17011

Posted: 04/12/2019 Job Number: 27002

Job title: Concurrent Review Nurse

Location: Camp Hill, Pennsylvania 17011

Work Schedule: Monday - Friday 8: 00am - 5: 00pm

Job Description:

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.

Job Responsibilities
  • 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

Requirements/ Education
  • Bachelors degree in Nursing preferred
  • Current states LPN/LVN or RN license.
  • Minimum of 1-2 years of Concurrent Review experience
  • Past/ current experience utilization review, case management, discharge planning, or   interqual 
If you are interested in setting up a phone interview screening please contact Ashley at 877-782-3334 or email

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