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 Louisville, KY (Onsite). Please review the job description below and contact me ASAP if you are interested.
Job ID:26-33643
Pay Range: $36 - $39/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, color, 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:26-33643
Pay Range: $36 - $39/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:
- Perform concurrent reviews of members to determine appropriate care and setting.
- Evaluate quality and continuity of care by analyzing acuity levels, resource consumption, length of stay, and discharge planning.
- Collaborate with Medical Affairs and/or Medical Directors regarding member care.
- Document and maintain concurrent review findings and discharge plans in health management systems.
- Work with healthcare providers to approve medical determinations based on concurrent review findings.
- Educate providers on utilization processes to ensure high-quality care.
- Provide feedback to leadership on opportunities for improvement in care levels and medical necessity.
- Review transfer or discharge plans to ensure timely transitions between care levels.
- Collaborate with care management on member referrals as appropriate.
- Comply with all policies and standards.
- RN License - Required
- 2+ years of acute care experience required.
- Experience in Utilization Review/Utilization Management/Concurrent Review required.
- Clinical knowledge to assess overall health and treatment needs preferred.
- Knowledge of Medicare and Medicaid regulations preferred.
- Familiarity with utilization management processes preferred.
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, color, 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