Spectraforce Technologies
Clinical Review Nurse - Concurrent Review
Spectraforce Technologies, Seattle, Washington, us, 98127
Overview
Position Title: Clinical Review Nurse-Concurrent Review
Work Location: Remote (West Coast sourcing only)
Assignment Duration: 02+ Months
Work Schedule: Training 8AM-5PM CST Mon-Fri (2 weeks, NO TIME OFF); 10-7 CST Monday-Friday; Holidays as needed with notice
Work Arrangement: Remote to West Coast (national sourcing but only West Coast)
Responsibilities
Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Specific to the denial letters. No member or provider outreach
Denial Letters for Concurrent Review
Daily Points are the measurement
Will work within TruCare Classic, Excel, Outlook, Word, OneNote.
TLAR Reduction
Qualifications & Experience
Education/Certification
Required: RN - Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing; Preferred:
Licensure
Required: TX or compact license; Preferred:
Years of experience required : 2 - 4 years of related experience; 2+ years of acute care experience required.
Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care (preferred).
Knowledge of Medicare and Medicaid regulations (preferred).
Knowledge of utilization management processes (preferred).
Disqualifiers : LPN, most recent position must be related field
Additional qualities to look for : Self-starter
Top 3 must-have hard skills stack-ranked by importance :
Self-Starter/independent worker
Time Management/attention to detail/accuracy
Flexibility - willing to jump around with volume shifts in specific areas
#J-18808-Ljbffr
Responsibilities
Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Specific to the denial letters. No member or provider outreach
Denial Letters for Concurrent Review
Daily Points are the measurement
Will work within TruCare Classic, Excel, Outlook, Word, OneNote.
TLAR Reduction
Qualifications & Experience
Education/Certification
Required: RN - Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing; Preferred:
Licensure
Required: TX or compact license; Preferred:
Years of experience required : 2 - 4 years of related experience; 2+ years of acute care experience required.
Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care (preferred).
Knowledge of Medicare and Medicaid regulations (preferred).
Knowledge of utilization management processes (preferred).
Disqualifiers : LPN, most recent position must be related field
Additional qualities to look for : Self-starter
Top 3 must-have hard skills stack-ranked by importance :
Self-Starter/independent worker
Time Management/attention to detail/accuracy
Flexibility - willing to jump around with volume shifts in specific areas
#J-18808-Ljbffr