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Concurrent Review Jobs in Georgia (NOW HIRING)

Monogram Health

Market Physician Executive

Atlanta, GA · Remote

Lead daily high-risk and concurrent review rounds. * Provide direct supervision of front-line clinical and operations team members, including regular shadowing/ride-alongs. * Oversee and delegate ...

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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?

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 popular job titles related to Concurrent Review jobs in Georgia?

For Concurrent Review jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Concurrent Review jobs in Georgia look for?

The top searched job categories for Concurrent Review jobs in Georgia are:

Concurrent Review jobs near you
Infographic showing various Concurrent Review job openings in Georgia as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 13% Part Time, 7% Contract, and 3% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Patient Account Rep. - Customer Service

Phoebe Putney Health System

Albany, GA • On-site

$16.50 - $21.75/hr

Full-time

This job post has expired 2 days ago. Applications are no longer accepted.

Job description

Qualifications
High School Diploma or GED (Required)
Work Experience
2 - 3 years a structured business environment (Required)
2 - 3 years hospital, Physician office or insurance environment (Preferred)
Licenses and Certifications
Required Certifications/Licensures:
CPAR certification or must be obtained within two years of employment
Essential Functions
ATTENTION TO BILLING DETAIL - PATIENT ACCOUNT REP:
Prepares billing and follow ups on claims in a timely manner.
Performs accurate and timely billing and account reviews ensuring that accurate information has been reviewed before sending to applicable payors or state agencies.
Conducts account review ensuring accurate billing information, enters and revises information as needed prior to claim being submitted.
Prepares adjustment bills, rebills, reprints claims and/or other source documents.
Processes failed claims in biller work file according to carrier specific requirements.
Coordinates with concurrent review precert nurse and/or admitting staff on precertification requirements.
Prepares daily productivity reports.
CUSTOMER SERVICE - PATIENT CLAIM ISSUES:
Serves as liaison between patient, employer, and carrier in resolving claim issues.
Communicates with patient, employer and carrier regarding claim status.
Processes patient inquiry requests within 24 hours.
Assists with Customer Service coverage duties as need arises.
KNOWLEDGE OF BUSINESS OFFICE DEPARTMENT GUIDELINES AND PROGRAMS:
Demonstrates knowledge of ever changing payer guidelines and regulations, programs and machines used.
Demonstrates mastery of computer programs and office machines used. Strong Performance includes mastery of the following skills, tasks and behaviors.
Creates and maintains via account notes, all correspondence, whether written or verbal, including discussion with carriers, patients or guarantors. Scans correspondence into system.
Submits Medicare Credit Balance Report quarterly, necessary to ensure that Phoebe Putney Memorial Hospital remains compliant with CMS rules and regulation.
Attends seminars and education relating to Medicare, Medicaid and Commercial.
Attends and participates in hospital and departmental staff meetings.
DOCUMENTATION:
Documents and submits required information and data in a timely fashion.
Clearly and accurately documents designated processes, policies, products, service offerings, etc.
Ensures that documentation is tailored to expected readers / users.
Uses correct terminology.
Conforms to required style and format.
Additional Duties
Adheres to the hospital and departmental attendance and punctuality guidelines.
Performs all job responsibilities in alignment with the core values, mission and vision of the organization.
Performs other duties as required and completes all job functions as per departmental policies and procedures.
Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs).
Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.
For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
Wears protective clothing and equipment as appropriate.

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