Hourly Wage Estimate: $41.90 - $62.87 / hour
Learn more about the benefits offered for this job.
The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.
Do you have the career opportunities as a Concurrent Review Nurse you want with your current employer? We have an exciting opportunity for you to join Pacific Partners Management Services which is part of the nation's leading provider of healthcare services, HCA Healthcare.
PPMSI offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
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Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation.
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Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
- Fertility and family building benefits through Progyny
- Free counseling services and resources for emotional, physical and financial wellbeing
- Family support, including adoption assistance, child and elder care resources and consumer discounts
- 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
- Employee Stock Purchase Plan
- Retirement readiness and rollover services and preferred banking partnerships
- Education assistance (tuition, student loan, certification support, dependent scholarships)
- Colleague recognition program
- Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
Our teams are a committed, caring group of colleagues. Do you want to work as a Concurrent Review Nurse where your passion for creating positive patient interactions are valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!
GENERAL SUMMARY OF DUTIES: The Concurrent Review Nurse ensures the timely review of admissions into acute, subacute and skilled nursing care facilities, determines admissions and the length of stay meet approved criteria and are medically appropriate.
DUTIES INCLUDE BUT NOT LIMITED TO:
- Using approved review criteria conduct telephonic or onsite admission and concurrent reviews of members admitted to acute, subacute, and skilled nursing care facilities
- Document admission, concurrent notes, review, and decisions in the Access Express utilization review system
- Apply approved criteria to evaluate whether a member’s care is timely, medically appropriate, and provided at the appropriate level
- Coordinate care and discharge plans with medical practitioners, facility utilization management staff and health plans
- Discuss complex or questionable cases with the Medical UM Leadership and the Medical Director to determine treatment options and/or discharge plans
- Contact providers and/or provider office staff, Medical Management staff or hospitalist staff to request additional medical information, as determined by the review or instructed by the Medical Directors
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Inform UM Leadership and Medical Director and Utilization Management Manager of system, operational and review issues
- Facilitate transfer of a member's care to a preferred provider when a member is admitted by or treated by non-preferred provider or admitted to non-contracted facility
- Assist the Medical Management staff in making arrangements to transfer a member to a contracted facility (e.g., ambulance, bed availability in receiving facility, etc.)
- Notify the health plans of members admitted to out of area facilities and coordinate with the health plan staff, the transfer of the member back into network when the member is medically stable
- Assist Case Managers with complex cases including developing treatment options, treatment plans, or discharge plans
- Function as a backup to the Case Management Staff when necessary
- Assume responsibility for special projects as assigned by the UM Leadership
- Evaluate performance of Case Managers and perform annual evaluations
- Train and, if necessary discipline, case managers. Escalate issues to UM Leadership as needed
- Coordinate and oversee 48 Hours and Concierge Programs with assistance of UM Leadership 17. Attend Medical Management Staff meetings
- Serve as a resource for on-site clinical and non-clinical staff
- Assist in Access Express Clinical Questions
- Perform other duties as assigned
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Current unrestricted California Registered Nurse/Licensed Vocational Nurse license required
- Three to Five years previous experience in the Utilization Review Department of a managed care organization or other comparable experience required
- This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved).
Physician Services Group is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare’s graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Concurrent Review Nurse opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
