Utilization Review Nurse - Concurrent review

IMCS Group is an IT, Healthcare, and Professional Staffing Company that helps Enterprises optimize the business value of their Staffing investments and enables them to achieve world-class business performance. IMCS Group supports strategic and operational aspects of IT implementations to help businesses implement growth strategies and leverage technology to achieve competitive advantage. In addition, IMCS provides hospitals and medical facilities with high-quality clinical professionals with the highest standards and compliance to provide the best medical care. At IMCS Group, quality and efficiency are of paramount importance. Our consistent growth, many successful customer engagements, and high customer retention are the hallmarks of our success. In addition, our passion for taking complex business processes and simplifying them by applying the right technology has been the key to our success. At all times, IMCS ensures the highest standards of quality in providing resources, time, and material to design, implement, and support to keep organizations operating efficiently.

Job Title: Clinical Review Nurse - Concurrent Review Duration: 06 months Contract to Hire Location: Remote-TX Shift Type: Tuesday – Saturday 8am-5pm CST- schedule is firm- no flexibility Payrate: $40-42/hr

Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collaborates with care management on referral of members as appropriate Performs other duties as assigned