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Concurrent Review Nurse
Ref No.: 19-00084
Location: French Camp, California
Concurrent Utilization Review Nurse
San Joaquin Valley, CA

Concurrent Utilization Review Nurse opportunity with an organization dedicated to community health and wellness in the San Joaquin Valley. Strong salary up to $100k++ and excellent Benefits, including CalPers Pension!

  • $90,000-$120,000++ Annual Salary based on experience
  • Benefits include Medical, Dental, Paid Time Off + Paid Holidays, Retirement Plans, State-sponsored Pension, Life Insurance, Disability Insurance, and more!
  • Time and a half paid after 8 hours (if and when overtime is available)
  • Ongoing training & opportunities for professional growth.

Conditions of Work:
  • Monday-Friday Daytime Hours
  • Ideal schedule with NO Nights, Weekends, Holidays & or Call!
  • RN may perform work in provider sites as well as team-based office settings.

Job Description:
  • Concurrent Utilization Review Nurse will evaluate the ongoing medical necessity of inpatient acute care.
  • Concurrent UR Nurse will partner with Providers to confirm member care plan, identify patient care issues, and offer solutions per guidelines.
  • Concurrent Utilization Review Nurse will conduct reviews on-site in provider offices and acute care facilities, as well as in a team-based office environment.
  • Concurrent UR Nurse will ensure that length of stay, transition of care, and discharge planning are appropriate and per insurance and regulatory compliance.
  • Concurrent Utilization Review Nurse will collaborate with the Medical Director to review requests for appeal as well as issue denials as requested.
  • 3+ years of RN experience in acute care (ICU, ER, MedSurg, Telemetry, or similar), long term care, skilled nursing, home care, hospice, or same hands-on patient care settings.
  • 2+ years of Utilization Review, Utilization Management, Concurrent Review, UR, or similar experience.
  • Knowledge of MediCal and Medicare guidelines strongly preferred.
  • Positive and professional with strong organizational and communication skills.