Concurrent Review Specialist (RN)-West region (PST)
Position: Concurrent Review Specialist
The Concurrent Review Specialist is an RN or LPN responsible for monitoring in real time the status of hospitalized and recently discharged health plan members. The Concurrent Review Specialist calls hospitals and other facilities daily to collect and analyze reasons for the admission or readmission and develops a concrete plan of action to keep the member healthy and prevent a readmission. Ideally, the Nurse will have experience in managed care and practical strategies around raising health outcomes through post-discharge member and provider engagement, concurrent review and/or utilization management. Experience in renal care and utilization management in acute and post-acute contexts preferred.
This position is Telecommute. Work will occur from a company corporate office, under a supervising clinician.
Position Requirements
Proven ability to help raise quality of care in an administrative medicine or managed care setting
Experience in discharge planning, utilization review management and application of clinical guidelines
Self-starter with ability to manage changing clinical data sets while thinking in a practical, action-oriented manner
Thrives in a very fast paced start up environment while embracing change with a "can do" attitude
Active RN or LPN license required
2+ years working in managed care, care management, utilization management and/or with CKD and ESRD patient
Roles and Responsibilities
Daily assistance with inpatient and concurrent calls to verify and confirm admission and obtain member information
Conduct outbound calls to hospitals, long-term care facilities and nursing homes each day to perform concurrent review
Weekly assistance with monitoring of skilled nursing facility discharges and ensuring that proper steps are in place for member follow-up.
Identify, track and conduct root cause analyses for Monogram members at high-risk for hospital admission/readmission
Obtain discharge orders and reports from hospital staff
Monitor clinical data feeds on hospitalized members and distill them into daily reports for case rounds
Lead daily clinical rounds for assigned POD
Develop plans with concrete care management action items to be undertaken by corporate and field clinicians
Apply evidence base best practice guidelines to access appropriate level of care
Collaborate with field clinicians who visit discharged members to assure quality care.
Maintains safe, secure, and healthy work environment by establishing and following standards and procedures and complying with legal regulations.
Other duties as assigned
Benefits
Highly competitive salary, commensurate with experience
Opportunity to work in a dynamic, fast-paced and innovative care management company that is transforming the delivery of kidney care
Comprehensive medical, dental, vision, and life insurance
Flexible paid leave & vacation policy
401(k) plan with matching contributions
Job Type: Full-time
At Monogram Health we believe in fostering an inclusive environment in which employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from all backgrounds and varying experiences.
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