Concurrent Review Nurse - Healthcare Specialist - Modesto - SAN JOAQUIN COUNTY HEALTH COMMISSION

    SAN JOAQUIN COUNTY HEALTH COMMISSION
    SAN JOAQUIN COUNTY HEALTH COMMISSION Modesto

    1 day ago

    Default job background
    Full time
    Description

    Job Title: Concurrent Review Nurse

    We are seeking a skilled Nurse to join our team as a Concurrent Review Nurse. This role plays a crucial part in ensuring that members receive the most appropriate care, at the right time and place.

    About the Role

    This is an exciting opportunity for a dedicated healthcare professional to work in a fast-paced environment. As a Concurrent Review Nurse, you will be responsible for conducting onsite and/or telephonic reviews of inpatient activities, ensuring compliance with regulatory and contractual requirements.

    Responsibilities

    • Confirm member care plans with providers and identify potential issues for resolution.
    • Collaborate with providers to resolve care issues, escalating when necessary.
    • Make timely and informed recommendations regarding transfers, level of care, and discharge planning.
    • Escalate non-standard requests to Medical Director for review and approval or denial of services.
    • Research and resolve adjudication issues accurately and efficiently.
    • Document activities in accordance with HPSJ standards.
    • Track data and compile reports as required.

    Requirements

    To be successful in this role, you will need:

    • Strong clinical skills in line with California scope of practice guidelines for RNs.
    • The ability to read, interpret, and apply complex written regulations, guidelines, and other materials.
    • Excellent communication and problem-solving skills.
    • Ability to work independently and as part of a team.

    Preferred Qualifications

    Candidates with experience in case management, utilization management, or discharge planning, as well as those familiar with managed care settings, Medi-Cal, and/or MediCare populations, will be highly valued.

    What We Offer

    As a Concurrent Review Nurse with us, you can expect:

    • A competitive salary of $83,000 - $105,000 per annum, depending on experience.
    • A comprehensive benefits package, including medical, dental, and vision insurance.
    • Paid time off, flexible holidays, and retirement plan options.
    • Ongoing education and training opportunities to support your career growth.

    About Us

    We are SAN JOAQUIN COUNTY HEALTH COMMISSION, a mission-driven organization committed to improving the health of our community. Our values include diversity, equality, and respect for all individuals.

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