Posted 6mo ago

Concurrent Review

@ Nevada Regional Medical Center
Nevada, Missouri, United States
OnsiteAll Commitments Available
Responsibilities:authorize stays, submit approvals, discharge planning
Requirements Summary:Nursing, respiratory care, or social work credential with licensure; knowledge of utilization review processes; ability to lift up to 50 lbs; standing/sitting/walking as needed.
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Job Description
Essential Functions:
  • Authorize patient stays
  • Submit insurance PA for hospital admission insurance.
  • Continued stay submissions
  • Discharge submission to insurance
  • Appeals and Peer to Peer submission
  • InterQual submission for medical necessity.
  • Discharge planning for BHU and Acute Care.
  • Conduct UR Committee.
  • CDI Management 
  • Swing Bed intake process
  • All other duties within the scope of practice. 
Working Conditions:
  • Possible exposure to inside environmental conditions.
  • Exposure to distressed patients, families or visitors.
Physical Demands:
  • Requires standing, sitting or walking for up to 8 hours or longer per day.
  • The ability to lift up to 50 lbs.
Qualifications:  
  • Graduate of an Accredited School of Practical Nursing or Registered Nursing or Graduate of an approved program in Respiratory Care or BSW/MSW from accredited school of social work required or similar education and experience; Missouri Licensure preferred