Concurrent Review Nurse 1
300 Corporate Center Drive Camp Hill, PA 17011
Job title: Concurrent Review Nurse
Location: Camp Hill, Pennsylvania 17011
Work Schedule: Monday - Friday 8: 00am - 5: 00pm
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
- 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