Concurrent Review Nurse (Solano area)

Concurrent Review Nurse (Solano area)

 

Come join a growing company that is making a difference in the delivery and management of healthcare services.  Hill Physicians Medical Group offers access to one of the most extensive medical networks in Northern California.

 

We have an immediate career opportunity for a Concurrent Review Nurse

 Workdays Monday through Friday; no holidays or weekendsSign on BonusFlexible schedulesCompany Bonus programUnlimited free nursing CEU programsTuition reimbursement

 

Responsibilities:

 

·  Conduct concurrent and retrospective review of inpatient and outpatient utilization according to approved criteria.

·  Support proactive discharge planning, transfers, and redirection.

·  Identify barriers to efficient utilization and facilitate resolution.

·  Reduce avoidable bed day use by applying applicable criteria and properly documenting decision.

·  Proactively and collaboratively interface with HMOs, physicians, and members and their families to assist in expediting appropriate discharge.

·  Refer members to various other departments for follow-up (i.e., Case Management, Disease Management, TPL, COB).

·  Utilize department standards for authorization turnaround time.

·  Issue denial letters in accordance with policy.

·  Support Medical Management Team authorizations, clinical initiatives, and other responsibilities.

 

 

 

Skills & Experience Required:

 

·  Active, unrestricted, California Nursing License.  Registered or Licensed Vocational Nurse.

·  Minimum three years' clinical nursing experience.

·  Excellent organizational and communication skills and ability to meet timeframes.

·  Ability to work effectively with a variety of customers including physicians, office staff, and members.

·  Ability to work independently and make appropriate decisions.

·  Computer skills.

·  Managed-care experience and certification preferred.

 

 

 

Send resume to Hill Physicians Medical Group c/o PriMed, P.O. Box 1161, San Ramon, CA  94583; Fax:  (925) 820-1826, or E-mail:  human.resources@hpmg.com

 

For additional information, visit our career center at

www.HillPhysicians.com