Do you want to work with an expanding team that values growth in addition to working for a company with fantastic benefits? We are seeking a Concurrent Review Nurse who is passionate about serving our community and providing high quality care to our members.

What You Will Be Doing:

This role involves conducing concurrent review of inpatient activities. In addition, this position is responsible for ensuring that member care is rendered at the most appropriate level, for the requisite length of time, in compliance with HPSJ, regulatory and contractual requirements.

The Day-To-Day:

• Confirms member care plan with provider.
• Identifies care issues and collaborates with provider to resolve; escalates as necessary.
• Makes timely and appropriate recommendations regarding transfers, determination of level of care and discharge planning.
• Escalates non-standard requests to Medical Director for review; approves or denies services as directed.
• Researches and resolves adjudication issues in an accurate and timely manner.
• Documents activities in appropriate HPSJ system(s) according to standards.
• Tracks data as required; compiles data for, produces and submits routine reports.