Lead Concurrent Review/Transition of Care Nurse, RN - 25-198

Hill Physicians Medical Group • Sacramento, CA

55d • $110,000 - $120,000

About The Position

Manages inpatient and outpatient utilization to assure that medical care is appropriate, efficient, and medically necessary.

Requirements

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

Nice To Haves

• Managed-care experience and certification preferred.

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.
• Participate in the 24-hour on-call access program.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: No Education Listed
• Number of Employees: 501-1,000 employees