HendersonRecruiter Since 2001
the smart solution for Henderson jobs

Concurrent Review RN

Company: P3 Health Group Management, LLC
Location: Henderson
Posted on: September 19, 2022

Job Description:

P3 Health Partners is committed to ensuring the health and safety of our team members, patients and communities we serve. As a part of this commitment, all candidates must receive their COVID-19 vaccine prior to joining the team. If you have any questions about our interview and hiring procedures, please contact PeopleServices@p3hp.org. Concurrent Review RN Overall Purpose: This position is responsible for compliance with the Medical Management Program Description of P3 Health Partners regarding Utilization Review, inclusive of prior authorization, on-site and telephonic, concurrent and retrospective review, discharge planning and transitions of care to the appropriate level. The Nurse adheres to the standard operating procedures that support achieving the Quadruple Aim: improved outcomes, improved patient experience, improved clinician experience and decreased cost of care. This Nurse will integrate and collaborate with hospitalists and emergency department staff, including physicians, to coordinate the functions of utilization review, discharge planning, care management and resource management into a singular effort. By achieving this the nurse ensures, based on patient assessment and best practice, that care is provided in the appropriate setting utilizing medically indicated and contracted resources. Education and Experience: + Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. + Ability to obtain and maintain current registration to practice as a Registered Nurse in multiple states. + Minimum four years of clinical nursing experience, including a minimum of two years in a managed care/HMO organization. + Previous ER and or ICU clinical experience preferred. + Case management and utilization management experience preferred. Proficient with computer and software programs (e.g.; Microsoft Word, Excel) and the Internet required. + Experience applying medical management treatment guidelines and nationally recognized criteria, such as InterQual / McKesson, MCG, or other practical management guidelines required. + Must be a self-starter, comfortable collaborating with physicians, hospital team members, patients and families; discussing appropriate levels of care that may be in conflict with requested service. + Must live in the Salem area-this is not a remote position. Essential Functions : + Promote the mission, vision and values of P3 Health Partners + Perform telephonic and on-site review of prior authorization, concurrent review and transition of care requests for appropriate care and setting, following guidelines and policies and approve services as per policy or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations + Perform reviews utilizing the appropriate hierarchy of criteria, to include but not limited to, health plan benefits, CMS, LCD/NCD, InterQual/MCG criteria + Perform discharge planning functions in collaboration with the facility and P3 Health Partners Medical Management stakeholders + Obtain additional clinical information from requesting provider or other sources when necessary for determinations + Complete medical necessity and level of care reviews for requested services using clinical judgment. Refer to Medical Directors for review depending on case findings + Collaborate, communicate and coordinate appropriate levels of care with hospitalists, specialists, emergency department staff, patients, families and P3 Medical Management stakeholders + Collaborate with various staff within provider networks and Medical Management teams electronically or telephonically to coordinate care + Educate providers on utilization and Medical Management processes + Provide clinical knowledge and act as a clinical resource to non-clinical team + Enter and maintain pertinent clinical information in various Medical Management systems + Address gaps in care EQUAL OPPORTUNITY EMPLOYERWe're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.DIVERSITY & INCLUSION At P3, we recognize and appreciate the importance of creating an environment in which all team members feel valued, included, and empowered to do their best work and bring great ideas to the tableEvery P3 family member's unique experiences, perspectives, and viewpoints are valued and support our ability to deliver the best possible experience for our patients, providers, payers, partners, and each other.Powered by JazzHR

Keywords: P3 Health Group Management, LLC, Henderson , Concurrent Review RN, Healthcare , Henderson, Nevada

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Log In or Create An Account

Get the latest Nevada jobs by following @recnetNV on Twitter!

Henderson RSS job feeds