Concurrent Review Nurse (Active Ca Rn License)

Overview:

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Concurrent Review RN.

*** Candidate must be authorized to work in USA without requiring sponsorship ***

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*** Location: 3300 Zinfandel Dr., Rancho Cordova, CA 95670 (100% remote)

*** Duration: 9 months contract w/ possibility of extension or conversion to FTE role

Notes:

• 100% remote role.
• Work Schedule: 8:00am – 5:00pm Pacific Time.

Description:

• Ensures proper procedure and diagnosis codes are reviewed for submitted procedures/claims.
• Solicits support from SME's, leads, and managers as appropriate.
• Triages and prioritizes cases to meet required Turn-around times.
• Expedites access to appropriate care for members with urgent needs.
• Prepares and submits clinical review cases to Medical Director (MD) for medical director oversight and necessity determination.
• Communicate determinations to providers and/or members to in compliance with state, federal, and accreditation requirements.
• Develops and reviews member-centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards.
• Identifies potential quality of care issues, service or treatment delays and intervenes or as clinically appropriate.
• Provides referrals to Case Management, Disease Management, Appeals and Grievance and Quality Departments, as necessary.
• Assists in the development and implementation of a proactive approach to improve and standardize overall retro claims review for clinical perspectives.
• May require weekend and holiday work and other duties as assigned.

Qualifications:

• Typically, requires a college degree or equivalent experience and 5 years of prior relevant experience.
• Nursing- 5 years minimum.
• RN License required. Current CA RN.
• Requires practical knowledge of job areas typically obtained through advanced education combined with experience.
• Knowledge of CPT-4, ICD-10, HCPCs, and provider billing practices.
• Knowledge of Medicare, Medi-Cal, and CMC Regulations and mandates.
• Demonstrate the ability to act independently using sound clinical judgment.
• Proficient in Microsoft Office (Outlook, Excel), Internet, Access database.

Additional (nice to have) Qualifications:

• Utilization Management. Long term care. LTSS.
• Experienced in working at Skilled Nursing Facility, Long Term Care Custodial Care, and Intermediate Care Facility for Developmental Disability, highly preferred.
• Experience in a fast-paced, production and quality environment preferred.
• Demonstrated efficient time management techniques and skills.
• Able to handle multiple tasks simultaneously while prioritizing cases to meet regulatory and business-based turnaround time.

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I'd love to talk to you if you think this position is right up your alley, and assure a prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.

Satwinder “Sat” Singh

Lead Technical Recruiter

Company Overview:

Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally, as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients’ businesses forward.

Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Applicants, with criminal histories, are considered in a manner that is consistent with local, state, and federal laws.

Job Types: Full-time, Contract

Salary: $55.00 - $62.00 per hour

Expected hours: 40 per week

Benefits:

• Health insurance

Healthcare setting:

• Long term care

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• Concurrent Review: 2 years (Required)
• Microsoft Office: 2 years (Required)
• Utilization Management: 1 year (Preferred)

License/Certification:

• California RN (Required)

Work Location: Remote