Inpatient Concurrent Review Nurse
Monday-Friday; 40 hours per week
Job Description as follows:
Coordination of inpatient admissions, management of entire stay with IPA and health care team.
Coordinate directly with the department of inpatient admissions, discharges and transfers as appropriate.
Facilitation of movement of the patient through the continuum of care
Communication with pcp to transition care from acute to ambulatory setting.
Cost-effective resource utilization and timely movement of patient through the continuum of care
Conduct and enter daily concurrent review, maintaining an accurate daily census report, usage of Milliman Guidelines.
Identification of eligibility and health plan benefits
Provided timely referral determination using Milliman Care Guidelines, appropriate language for deferrals/denials, correct coding, and selecting appropriate providers.
Ability to maintain compliance in turnaround time by working diligently and responsibly with time frame given.
About the Agency:
Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information! LVN