Concurrent Review Nurse

Location: Tacoma, WA
Date Posted: 08-01-2018
Concurrent Review Nurse (RN or LPN)
Tacoma, WA

Concurrent Review Nurse Job Summary:
  • The Concurrent Review Nurse is responsible for the timely and rapid utilization management and utilization review of emergent/urgent services provided to members, as well as continued stay requests, in order to verify medical necessity against an establish criteria.
  • The Concurrent Review Nurse will perform reviews of services and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
  • Utilize clinical skills to telephonically provide and facilitate utilization review, continued stay reviews and utilization management of all cases based on clinical experience and recognized guidelines.
  • The Concurrent Review Nurse will obtain the information necessary to assess a member's clinical condition, identify ongoing clinical care needs and ensure that members receive services in the most optimal setting to effectively meet their needs.
Concurrent Review Nurse Background:
  • Current, valid, and unrestricted state Registered Nurse (R.N.) or Licensed Practical Nurse (L.P.N.) license.
  • CCM or CPUR or similar certification is preferred.
  • 2 years acute care clinical nursing experience is required.
  • 1 year of recent experience in Utilization Review and Case Management at a health plan or other managed care organization (HMO/TPA/IPA/etc).
  • Knowledge of guidelines for Medicaid/Medicare and related state programs is required.
  • Experience using Milliman or InterQual criteria for medical necessity, setting and level of care, and concurrent patient management.
  • Computer skills to include Microsoft Word, Excel, database use, and basic data entry.
480.264.0620 (CALL – TEXT – FAX)
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