Nurse, Concurrent Review

Responsibilities: Perform concurrent inpatient utilization reviews using InterQual criteria to determine medical necessity for admissions and continued stays. Collaborate with physicians and care teams to support appropriate level-of-care decisions and maintain detailed clinical documentation.

Requirements: Requires an active unrestricted USRN license and at least two years of experience in an acute care setting. Proficiency in Microsoft Office and familiarity with inpatient level-of-care criteria are essential.

Key skills: Concurrent Review, InterQual Criteria, Utilization Management, Case Management, Clinical Collaboration, Medical Necessity Determination, HIPAA Compliance, URAC Standards, NCQA Standards, Microsoft Office, Critical Thinking, Time Management

Keywords: InterQual, Utilization Review, Medical Necessity, USRN, BSN, HIPAA, URAC, NCQA, Acute Care, Case Management, Inpatient Review, Transitional Care, HealthHelp, Clinical Intake, Payer Guidelines