New 
Clinical Review Nurse - Concurrent Review
 Spectraforce Technologies | |
 United States, North Carolina, Raleigh | |
| 500 West Peace Street (Show on map) | |
 Jan 09, 2025 | |
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Clinical Review Nurse - Concurrent Review 3 Months Remote 100% Monday - Friday 8-5 PM - any time zone is okay. Job Opening: * Responsible for managing facilities for acute care in patient stays. * Initial reviews, concurrent stay review & discharges (beginning, middle & end) * Being a team player - lots of collaboration * Role is independent but the team works together on many items. * Being able to prioritize tasks. Describe the performance expectations/metrics for this individual and their team: * Productivity metrics - how many authorizations they complete per day. * Weighted productivity - credit is given for certain tasks (sending out a denial letter, building an authorization, gathering additional details & information) * Team does complete audits - may be more relevant when they are converted (meeting criteria, completing authorizations appropriately) * High pressure turn around times (sometimes they must be able to complete an authorization within 24 hours) Tell me about what their first day looks like: * 4 week training with learning and development - once completed they will be working with the preceptor (no exact timeline, based on individual performance & understanding) * Will be working within TruCare, Interqual (will be trained on systems) * IT training * Compliance training * Will be assigned a preceptor that will be there to support them through training and ensuring they are on the right path What previous job titles or background work will be in this role? * UM experience, prior authorization. What makes your team/department/culture special that you would like candidates to know? * Not having acute care experience, Team will hire LPN but generally they do not have the experience the team needs (physician office, nursing home) Any future projected positions potentially coming up? Choose an item. If yes, note: Internal/External Groups with which the Candidate will interface: Required Skills/Experience: 1. acute care experience (ICU, med surg) and compact license. health of member including treatment needs and appropriate level of care preferred. 2. UM experience - not a dealbreaker, is teachable Knowledge of Medicare and Medicaid regulations preferred. 3. Multitasking, organization, fast paced Knowledge of utilization management processes preferred. Education Requirement: Requires Graduate from an Accredited School of Nursing or bachelor's degree in nursing and 2 - 4 years of related experience. Education Preferred: Software Skills Required: TruCare, Interqual (Preferred) - Microsoft Office Platform - EXCEL is helpful as the team does use for daily reporting (general understanding) typing skills | |