Concurrent Review Nurse
Miami, FL · On-site
Concurrent Review Nurse Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality ...
Concurrent Review Nurse
Miami, FL · On-site
Concurrent Review Nurse Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality ...
Concurrent Review Nurse
Miami, FL · On-site
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.
Concurrent Review Nurse
Miami, FL · On-site
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.
Concurrent Review Nurse
Doral, FL · On-site
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.
Concurrent Review Nurse
Doral, FL · On-site
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.
Concurrent Review Nurse
Doral, FL · On-site
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.
Concurrent Review Nurse
Doral, FL · On-site
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.
RN - Utilization Review or Concurrent Review
Fort Myers, FL · On-site
$2.1K/wk
Details Client Name Lee Health-Corporate Center Job Type Travel Offering Nursing Profession RN Specialty Utilization Review or Concurrent Review Job ID 18935027 Job Title RN - Utilization Review or ...
RN - Utilization Review or Concurrent Review
Fort Myers, FL · On-site
$2.1K/wk
Details Client Name Lee Health-Corporate Center Job Type Travel Offering Nursing Profession RN Specialty Utilization Review or Concurrent Review Job ID 18935027 Job Title RN - Utilization Review or ...
Travel RN - Utilization Review or Concurrent Review Genie Healthcare is looking for a RN to work in Utilization Review or Concurrent Review for a 12.71 weeks travel assignment located in Fort Myers ...
Travel RN - Utilization Review or Concurrent Review Genie Healthcare is looking for a RN to work in Utilization Review or Concurrent Review for a 12.71 weeks travel assignment located in Fort Myers ...
Daily Responsibilities of Registered Nurse Concurrent Review; * Telephonically review inpatient admissions to assure appropriate level of care and medical necessity * Review admissions through ...
Daily Responsibilities of Registered Nurse Concurrent Review; * Telephonically review inpatient admissions to assure appropriate level of care and medical necessity * Review admissions through ...
Field IP Concurrent Review Nurse
$73K - $90K/yr
If denied, all required regulatory and Plan P&P's must be followed) Concurrent review findings, but not limited to: Significant changes in the members physical and/or mental status Significant ...
Field IP Concurrent Review Nurse
$73K - $90K/yr
If denied, all required regulatory and Plan P&P's must be followed) Concurrent review findings, but not limited to: Significant changes in the members physical and/or mental status Significant ...
Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate ...
Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate ...
RN IP Concurrent Review
$26 - $33/hr
... Florida Concurrent review experience - 2 year minimum experience Managed Care experience - 1-2 year minimum experience Experience with Medicaid and Medicare Practice experience in the areas of ...
RN IP Concurrent Review
$26 - $33/hr
... Florida Concurrent review experience - 2 year minimum experience Managed Care experience - 1-2 year minimum experience Experience with Medicaid and Medicare Practice experience in the areas of ...
Our expanding managed care company is seeking RNs for positions in concurrent review and prior authorizations for our Sunrise office. This is a M-F daytime (no holidays/no weekends) fulltime position.
Our expanding managed care company is seeking RNs for positions in concurrent review and prior authorizations for our Sunrise office. This is a M-F daytime (no holidays/no weekends) fulltime position.
Field RN - Concurrent Review
$68K - $87K/yr
Company Description Why You Should Work For Us: HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of ...
Field RN - Concurrent Review
$68K - $87K/yr
Company Description Why You Should Work For Us: HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of ...
Review inpatient admissions to assure appropriate level of care and medical necessity for members. 100% Onsite/Telephonic Review inpatient admissions to assure appropriate level of care and medical ...
Review inpatient admissions to assure appropriate level of care and medical necessity for members. 100% Onsite/Telephonic Review inpatient admissions to assure appropriate level of care and medical ...
Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of ...
Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of ...
Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of ...
Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of ...
Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of ...
Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of ...
Utilization Review RN
$30 - $32/hr
Are you an experienced Registered Nurse with Utilization Review or Concurrent Review experience looking for a new opportunity with a prestigious Managed Care Company? Do you want the chance to ...
Utilization Review RN
$30 - $32/hr
Are you an experienced Registered Nurse with Utilization Review or Concurrent Review experience looking for a new opportunity with a prestigious Managed Care Company? Do you want the chance to ...
Calls insurance companies to obtain precertification or concurrent with the level of care. * Attend ... review processes
Calls insurance companies to obtain precertification or concurrent with the level of care. * Attend ... review processes
Concurrent Review information
What is concurrent review in healthcare?
Concurrent review is a process used in healthcare to assess the necessity and appropriateness of ongoing inpatient care while the patient is still hospitalized. The goal is to ensure that medical services are being delivered efficiently and according to established guidelines. Utilization review nurses or case managers typically conduct these reviews by evaluating medical records, communicating with providers, and making recommendations regarding continued stay or discharge planning. This helps control healthcare costs and improves patient outcomes by preventing unnecessary treatments or extended hospitalizations.
What are some common challenges faced by concurrent review nurses, and how can they be managed?
Concurrent Review nurses often face challenges such as managing a high volume of case reviews within tight deadlines and ensuring timely communication with providers and insurance companies. Staying organized, utilizing efficient documentation systems, and maintaining up-to-date knowledge of regulatory requirements can help overcome these hurdles. Collaboration with interdisciplinary teams and regular training on evolving guidelines are also essential for success in this role.
What are the key skills and qualifications needed to thrive as a concurrent review nurse, and why are they important?
To thrive as a Concurrent Review Nurse, you need a strong clinical background, current RN licensure, and a thorough understanding of utilization management and healthcare regulations. Familiarity with case management software, electronic health records (EHRs), and knowledge of insurance guidelines and ICD/CPT coding is typically required. Excellent analytical thinking, communication skills, and attention to detail help in collaborating with providers and ensuring appropriate care. These competencies are crucial for ensuring patients receive medically necessary care while maintaining compliance and cost-effectiveness.
What is the difference between Concurrent Review vs Utilization Review?
| Aspect | Concurrent Review | Utilization Review |
|---|---|---|
| Purpose | Assess ongoing patient care during hospitalization | Evaluate the necessity and appropriateness of services, often before or after care |
| Timing | Performed in real-time during treatment | Can be pre-authorization, concurrent, or retrospective |
| Work Environment | Hospitals, clinics, insurance companies | Insurance companies, healthcare organizations |
| Credentials | Registered nurses, case managers, healthcare professionals | Medical reviewers, nurses, case managers |
Concurrent Review focuses on evaluating ongoing patient care during hospitalization, ensuring treatments are appropriate in real-time. Utilization Review has a broader scope, including pre-authorization and retrospective assessments to determine the necessity of services. While both roles involve healthcare professionals and are used within insurance and healthcare settings, their timing and specific focus differ.
What are popular job titles related to Concurrent Review jobs in Florida?
For Concurrent Review jobs in Florida, the most frequently searched job titles are:
- No Experience Utilization Management Nurse
- Evening Utilization Review Nurse
- Contract Utilization Review Nurse
- Medical Claim Review Nurse
- Per Diem Utilization Review Nurse
- Seasonal Remote Hedis Review Nurse
- Utilization Review Physician
- Part Time Utilization Review Nurse
- Night Utilization Review Nurse
- Optum Clinical Claim Review Nurse
What job categories do people searching Concurrent Review jobs in Florida look for?
The top searched job categories for Concurrent Review jobs in Florida are:
- Case Manager Utilization Review Nurse
- Remote Lpn Utilization Review
- Remote Weekend Utilization Review
- Remote Utilization Review
- Utilization Review No Experience
- Remote Utilization Review Nurse Practitioner
- Remote Dental Utilization Review
- Lpn Utilization Review Work From Home
- Anthem Utilization Review Nurse
- Remote Bcba Utilization Review
Job description
Concurrent Review Nurse
Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care. This is achieved through the review of inpatient admissions, outpatient precertification, and prior authorization requests, using established medical policies, evidence-based guidelines, and managed care standards.
Essential Duties and Responsibilities- Lead, train, and support both clinical and non-clinical staff in accordance with Leon Health's policies and procedures to ensure efficient and effective performance.
- Monitor and respond to incoming calls and written inquiries from members, providers, and internal departments.
- Oversee the quality, accuracy, and timeliness of prior authorization reviews and ensure appropriate prioritization.
- Enter service requests and determination data into the appropriate systems in compliance with regulatory requirements and organizational policies.
- Review clinical documentation for precertification and concurrent (ongoing) reviews.
- Perform on-site and/or telephonic reviews to determine the appropriateness of inpatient and outpatient care settings, using medical policies, CMS guidelines, and industry standards.
- Conduct medical and behavioral health (BH) reviews for pre- and post-service authorization requests.
- Issue authorizations for inpatient admissions, outpatient services, and post-service requests to providers, facilities, and members as applicable.
- Refer complex cases to a Medical Director or Behavioral Health Practitioner when additional clinical evaluation is required.
- Ensure all documentation is complete, accurate, and clearly supports authorization decisions.
- Process denial determinations in compliance with regulatory standards and internal policies.
- Maintain up-to-date census reports, daily notes, and authorization records, including tracking admissions and discharges.
- Collaborate with healthcare providers to obtain necessary clinical documentation for medical necessity determinations.
- Work with providers to proactively identify discharge needs and assist in care planning.
- Facilitate smooth care transitions across the healthcare continuum by coordinating with facilities and the Care Management team.
- Bachelor's degree in Nursing required
- Minimum of two (2) years of experience in clinical review or utilization management
- Bilingual in English and Spanish (required)
About Leon Medical Centers
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Miami, FL, US
Year founded
1996