Immediate need for a talented Clinical - Clinical Review Nurse - Concurrent Review. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:26-33642
Pay Range: $36.50 - $39.10/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
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Job ID:26-33642
Pay Range: $36.50 - $39.10/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Conduct concurrent reviews of inpatient medical stays to evaluate medical necessity and appropriate levels of care.
- Assess members' clinical conditions, acuity levels, resource utilization, and length of stay.
- Review and support discharge planning to facilitate timely transitions between care settings and facilities.
- Collaborate with healthcare providers, Medical Affairs, and Medical Directors regarding clinical findings and medical determinations.
- Document review findings, discharge plans, and follow-up actions accurately in health management systems.
- Coordinate with care management teams for appropriate member referrals.
- Provide guidance to providers regarding utilization management processes and applicable clinical guidelines.
- Identify opportunities to improve care quality, continuity, and appropriate resource utilization.
- BSN qualification.
- Background in ICU, medical-surgical nursing, acute care, or inpatient clinical settings.
- Experience with concurrent reviews, medical necessity assessments, and discharge planning.
- Graduate of an accredited nursing school or a bachelor's degree with 2–4 years of related experience.
- Active RN license issued by Kentucky or a valid multistate compact nursing license.
- Previous utilization management experience is required.
- Strong clinical assessment and critical-thinking skills.
- Excellent computer proficiency and the ability to navigate clinical documentation systems.
- Strong multitasking, organizational, and time-management abilities.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
#prof