Registered Nurse (RN), Concurrent Review
Are you a detail-oriented Registered Nurse with experience in managed care who is interested in the nuts-and-bolts of the health insurance world?
Are you looking to transfer your nursing skills from a hands-on environment to a telephonic office environment?
Then you might want to consider this opportunity!
Repucare is partnered with a large Managed Care Company in Indianapolis to provide Concurrent Review Nurses to help support their Utilization Review process.
The Concurrent Review Nurse promotes the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay requests.
Additional Duties of Concurrent Review Nurse (RN)
• Performs onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approves services or forwards requests to the appropriate Physician or Medical Director with recommendations for other determinations.
• Completes medical necessity and level of care reviews for requested services using clinical judgment and referring to Medical Directors for review depending on case findings.
• Collaborates with various staff within provider networks and Case Management team electronically or telephonically to coordinate member care.
• Conducts discharge planning, depending on individual members' needs.
• Educate providers on utilization and medical management processes.
• Provide clinical knowledge and acts as a clinical resource to non-clinical team staff.
• Enters and maintains pertinent clinical information in various medical management systems.
This full-time, non-exempt position is performed onsite at one of RepuCare's large managed care clients in downtown Indianapolis, and has an attractive salary. This is a fully benefited position. An excellent opportunity to show what you can do and start a long term career with an exciting company that is growing.
Requirements
- Current, unrestricted Indiana RN license.
- 3+ years of clinical nursing experience in an acute care/hospital setting required.
- Knowledge of Managed Care principles and Medicaid experience preferred/1 year MCO experience
RepuCare is a certified, woman-owned business (WBE) and a leading provider of medical management solutions for corporate, state and federal healthcare programs.