Unividamedicalcenters
We are seeking a skilled and compassionate Concurrent Review Nurse to join our team, providing telephonic clinical review and care coordination for Medicare Advantage patients. This role focuses on ensuring quality care, medical necessity, and compliance with Medicare Advantage guidelines.
Example of Duties
Concurrent Review: Conduct telephonic reviews of inpatient, ER and Observation services to assess medical necessity, appropriateness, and compliance with Medicare Advantage HMO policies and CMS guidelines. Cases discussed with admitting providers to validate medical need of the services. Care Coordination: Collaborate with healthcare providers, case managers, and patients to ensure timely and appropriate care delivery, facilitating discharge planning and transitions of care, being sure all patient’s needs are available at the moment of transfer to a lower level of care. Patient Advocacy: Communicate with patients to provide education, clarify treatment plans, and address concerns, ensuring a positive patient experience. Compliance and Documentation: Maintain accurate and timely documentation in electronic health record (EHR) systems, ensuring compliance with regulatory standards and organizational protocols. Desirable knowledge, abilities and skills
Minimum of 3 years of clinical nursing experience, preferably in acute care, case management, or utilization review. Experience with Medicare Advantage HMO plans and CMS regulations strongly preferred. Prior telephonic or remote nursing experience is a plus. Strong knowledge of utilization management principles and clinical guidelines (e.g., InterQual, Milliman). Excellent communication and interpersonal skills for telephonic patient and provider interactions. Proficiency in EHR systems and Microsoft. Ability to work independently, prioritize tasks, and manage time effectively in a fast-paced environment. Analytical skills to assess clinical documentation and make evidence-based decisions. Education & Experience
Associate’s or Bachelor’s degree in Nursing (BSN preferred). Active, unrestricted Registered Nurse (RN) license in the state of Florida. Certified Case Manager (CCM) or Utilization Management Certification preferred but not required. Travel
Physical Requirements / Working Enviroment
Full-time, Monday through Friday, with occasional on-call or weekend requirements based on organizational needs. Disclaimer
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any position. Employees may be directed to perform job-related tasks other than those specifically presented in this description. To apply for the
Concurrent Review Nurse
position, please fill out the following form: Apply Online
Email * A valid email address is required. Phone * United States +1 United Kingdom +44 American Samoa +1 Antigua and Barbuda +1 Argentina +54 Aruba +297 Australia +61 Belize +501 Bermuda +1 Bolivia +591 British Indian Ocean Territory +246 British Virgin Islands +1 Burkina Faso +226 Cameroon (Cameroun) +237 Canada +1 Caribbean Netherlands +599 Chad (Tchad) +235 Chile +56 Christmas Island +61 Colombia +57 Cook Islands +682 Costa Rica +506 Cuba +53 Djibouti +253 Dominica +1 Eritrea +291 Estonia (Eesti) +372 Ethiopia +251 Falkland Islands (Islas Malvinas) +500 Finland (Suomi) +358 France +33 Gabon +241 Grenada +1 Guadeloupe +590 Guam +1 Guatemala +502 Guernsey +44 Honduras +504 Iceland (Ísland) +354 Ireland +353 Isle of Man +44 Italy (Italia) +39 Jamaica +1 Jersey +44 Kiribati +686 Malaysia +60 Mali +223 Marshall Islands +692 Mauritius (Moris) +230 Mayotte +262 Montserrat +1 Nauru +674 Netherlands (Nederland) +31 Niue +683 Norfolk Island +672 Northern Mariana Islands +1 Norway (Norge) +47 Paraguay +595 Philippines +63 Poland (Polska) +48 Portugal +351 Saint Helena +290 Saint Kitts and Nevis +1 Saint Lucia +1 Saint Vincent and the Grenadines +1 Samoa +685 San Marino +378 Solomon Islands +677 South Africa +27 Svalbard and Jan Mayen +47 Togo +228 Tonga +676 Turkmenistan +993 Turks and Caicos Islands +1 U.S. Virgin Islands +1 Uganda +256 United Kingdom +44 United States +1 Uruguay +598 Vanuatu +678 Wallis and Futuna (Wallis-et-Futuna) +681 UniVida Medical Centers arose out of the need to improve the quality of medical care in our community. Our company is based on delivering optimal and personalized patient care. Excellence of care is achieved through the collaboration of the highest qualified physicians in the community, delivery of world-class services, leading-edge technology, education, and focus on preventative care Copyright by UniVida Medical Center 2025. All rights reserved.
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Concurrent Review: Conduct telephonic reviews of inpatient, ER and Observation services to assess medical necessity, appropriateness, and compliance with Medicare Advantage HMO policies and CMS guidelines. Cases discussed with admitting providers to validate medical need of the services. Care Coordination: Collaborate with healthcare providers, case managers, and patients to ensure timely and appropriate care delivery, facilitating discharge planning and transitions of care, being sure all patient’s needs are available at the moment of transfer to a lower level of care. Patient Advocacy: Communicate with patients to provide education, clarify treatment plans, and address concerns, ensuring a positive patient experience. Compliance and Documentation: Maintain accurate and timely documentation in electronic health record (EHR) systems, ensuring compliance with regulatory standards and organizational protocols. Desirable knowledge, abilities and skills
Minimum of 3 years of clinical nursing experience, preferably in acute care, case management, or utilization review. Experience with Medicare Advantage HMO plans and CMS regulations strongly preferred. Prior telephonic or remote nursing experience is a plus. Strong knowledge of utilization management principles and clinical guidelines (e.g., InterQual, Milliman). Excellent communication and interpersonal skills for telephonic patient and provider interactions. Proficiency in EHR systems and Microsoft. Ability to work independently, prioritize tasks, and manage time effectively in a fast-paced environment. Analytical skills to assess clinical documentation and make evidence-based decisions. Education & Experience
Associate’s or Bachelor’s degree in Nursing (BSN preferred). Active, unrestricted Registered Nurse (RN) license in the state of Florida. Certified Case Manager (CCM) or Utilization Management Certification preferred but not required. Travel
Physical Requirements / Working Enviroment
Full-time, Monday through Friday, with occasional on-call or weekend requirements based on organizational needs. Disclaimer
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any position. Employees may be directed to perform job-related tasks other than those specifically presented in this description. To apply for the
Concurrent Review Nurse
position, please fill out the following form: Apply Online
Email * A valid email address is required. Phone * United States +1 United Kingdom +44 American Samoa +1 Antigua and Barbuda +1 Argentina +54 Aruba +297 Australia +61 Belize +501 Bermuda +1 Bolivia +591 British Indian Ocean Territory +246 British Virgin Islands +1 Burkina Faso +226 Cameroon (Cameroun) +237 Canada +1 Caribbean Netherlands +599 Chad (Tchad) +235 Chile +56 Christmas Island +61 Colombia +57 Cook Islands +682 Costa Rica +506 Cuba +53 Djibouti +253 Dominica +1 Eritrea +291 Estonia (Eesti) +372 Ethiopia +251 Falkland Islands (Islas Malvinas) +500 Finland (Suomi) +358 France +33 Gabon +241 Grenada +1 Guadeloupe +590 Guam +1 Guatemala +502 Guernsey +44 Honduras +504 Iceland (Ísland) +354 Ireland +353 Isle of Man +44 Italy (Italia) +39 Jamaica +1 Jersey +44 Kiribati +686 Malaysia +60 Mali +223 Marshall Islands +692 Mauritius (Moris) +230 Mayotte +262 Montserrat +1 Nauru +674 Netherlands (Nederland) +31 Niue +683 Norfolk Island +672 Northern Mariana Islands +1 Norway (Norge) +47 Paraguay +595 Philippines +63 Poland (Polska) +48 Portugal +351 Saint Helena +290 Saint Kitts and Nevis +1 Saint Lucia +1 Saint Vincent and the Grenadines +1 Samoa +685 San Marino +378 Solomon Islands +677 South Africa +27 Svalbard and Jan Mayen +47 Togo +228 Tonga +676 Turkmenistan +993 Turks and Caicos Islands +1 U.S. Virgin Islands +1 Uganda +256 United Kingdom +44 United States +1 Uruguay +598 Vanuatu +678 Wallis and Futuna (Wallis-et-Futuna) +681 UniVida Medical Centers arose out of the need to improve the quality of medical care in our community. Our company is based on delivering optimal and personalized patient care. Excellence of care is achieved through the collaboration of the highest qualified physicians in the community, delivery of world-class services, leading-edge technology, education, and focus on preventative care Copyright by UniVida Medical Center 2025. All rights reserved.
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