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Concurrent Review Jobs in Florida (NOW HIRING)

Palm Medical Centers

Concurrent Review Nurse

Miami, FL · On-site

The Concurrent Review Nurse is responsible for performing utilization management activities to ensure medical services are delivered effectively, efficiently, and appropriately. This includes ...

Miami Jewish Health

Utilization Review Nurse

Miami, FL · On-site

Concurrent Review & Care Progression * Conducts timely concurrent reviews with hospitals and facilities to assess clinical stability, treatment response, and discharge readiness. * Reviews clinical ...

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Concurrent Review information

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 a concurrent review?

A concurrent review is a process used in healthcare and insurance jobs where a professional evaluates a patient's case or claim while treatment or services are ongoing. This review helps determine the appropriateness, necessity, and efficiency of care in real-time, often requiring knowledge of medical records and insurance policies. It is commonly performed by healthcare professionals, case managers, or claims reviewers to ensure quality and compliance.

What is an example of a concurrent review?

A concurrent review is a process used by healthcare professionals, including those in roles like Concurrent Review, to evaluate a patient's treatment and progress while they are still receiving care. For example, reviewing a patient's hospital stay daily to determine if continued hospitalization is necessary or if care can be transitioned to outpatient services. This process helps ensure appropriate utilization of resources and timely care adjustments.

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.

How to make an extra 2000 a month as a nurse?

Concurrent Review nurses can increase their income by taking on overtime shifts, working in high-demand specialties, or pursuing certifications that qualify them for higher-paying roles. Additionally, some may supplement income through per diem work, telehealth services, or consulting opportunities within their field.

What is the difference between Concurrent Review vs Utilization Review?

AspectConcurrent ReviewUtilization Review
PurposeAssess ongoing patient care during hospitalizationEvaluate the necessity and appropriateness of services, often before or after care
TimingPerformed in real-time during treatmentCan be pre-authorization, concurrent, or retrospective
Work EnvironmentHospitals, clinics, insurance companiesInsurance companies, healthcare organizations
CredentialsRegistered nurses, case managers, healthcare professionalsMedical 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 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.

How to make 300,000 as a nurse?

To earn $300,000 as a nurse, professionals typically work in high-paying specialties such as nurse anesthetist, nurse practitioner, or clinical nurse specialist, often requiring advanced certifications and a master's or doctoral degree. Gaining experience, working overtime, and seeking employment in high-demand settings or geographic areas with higher pay can also increase earnings.
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:
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:
Concurrent Review jobs near you
Infographic showing various Concurrent Review job openings in Florida as of July 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 83% In-person, and 17% Remote job distribution.

Concurrent Review Nurse

Palm Medical Centers

Coral Gables, FL • On-site

Full-time

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Position Summary:
The Concurrent Review Nurse is responsible for performing utilization management activities to ensure medical services are delivered effectively, efficiently, and appropriately. This includes reviewing inpatient admissions and ongoing hospital stays to determine medical necessity, appropriateness of care, and length of stay in accordance with clinical guidelines and payer requirements.
Key Responsibilities:
  • Conduct timely and accurate concurrent reviews of inpatient hospitalizations and other levels of care.
  • Evaluate clinical documentation against evidence-based criteria (e.g., InterQual®, MCG) to determine medical necessity and appropriate level of care.
  • Collaborate with physicians, hospital staff, and insurance companies to coordinate patient care and discharge planning.
  • Communicate utilization review decisions and recommendations to providers and payers.
  • Document all reviews, decisions, and communications in accordance with regulatory and organizational standards.
  • Identify cases requiring escalation or peer review and follow established procedures.
  • Ensure compliance with CMS guidelines, accreditation standards (e.g., NCQA, URAC), and HIPAA.
  • Participate in quality improvement initiatives and departmental meetings
Qualifications:
Education & Licensure:
  • Registered Nurse (RN) license, active and in good standing, required.
  • Associate or Bachelor's degree in nursing (BSN preferred).
Experience:
  • Minimum 2 years of clinical experience (e.g., med-surg, critical care).
  • At least 1 year of utilization review, case management, or managed care experience preferred.
Skills & Competencies:
  • Knowledge of InterQual®, MCG, or other clinical review guidelines.
  • Familiarity with Medicare/Medicaid and commercial insurance regulations.
  • Strong analytical and clinical judgment skills.
  • Effective communication and negotiation skills.
  • Proficient with electronic medical records (EMRs) and utilization review platforms.
  • Detail-oriented with excellent organizational skills.
Work Environment:
  • Corporate Office

Palm Medical Centers is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Palm Medical Centers makes hiring decisions based solely on qualifications, merit, and business needs at the time.

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