Clinical Review Nurse Concurrent Review Job at Pacer Group, Texas

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  • Pacer Group
  • Texas

Job Description

Job Title: Clinical Review Nurse Concurrent Review

Assignment Duration: 6 Months (Contract-to-Hire Possibility)

Location: Remote (Must hold a Compact RN License valid in Texas)

Schedule: Candidate would be working Saturday & Sunday - they would then pick their two consecutive days they do not want to work (Monday, Tuesday) (Tuesday, Wednesday) (Thursday, Friday) working remainder of the week

Job Description

Key Responsibilities:

  • Conducts concurrent reviews of inpatient cases for medical necessity and appropriate care level
  • Determines member's overall health and assists with discharge planning
  • Collaborates with healthcare providers and medical directors on care plans
  • Documents findings and actions in health management systems
  • Provides feedback to leadership for care improvement opportunities
  • Works with providers to educate on utilization management processes
  • Refers members to care management teams when appropriate
  • Complies with all internal policies and regulatory standards

Required Education & Experience:

  • Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
  • 2 4 years of related nursing experience

Preferred Qualifications:

  • Clinical knowledge of treatment planning and level of care determination
  • Familiarity with Medicare and Medicaid regulations
  • Experience with utilization management processes

Licensure / Certification:

  • Required: Active RN License (Compact license applicable to Texas)
  • LPNs not accepted

Typical Day in the Role:

  • Standard hours: 8 AM 5 PM CST
  • Work queue-based reviews from home
  • Use of 3 screens (1 laptop, 2 monitors)
  • Work closely with team leads and peers to meet strict daily deadlines
  • Heavy multitasking in multiple systems
  • Focus on reviewing faxes and cases for medical necessity

Disqualifiers:

  • Less than 2 years of nursing experience
  • No RN license or non-compact license
  • Licensed Practical Nurses (LPNs) not considered

Job Tags

Contract work, Remote work, Weekend work, Sunday, Saturday,

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