Concurrent Review RN

Summary/Position Objectives:
Provides on-site review of medical record documentation to support medical necessity of treatment in the inpatient hospital and extended care settings. This is accomplished through admission certification and continued stay certification according to Milliman and Robertson Guidelines and Interqual intensity of service and severity of illness criteria.

Full time and part time positions available.


Responsibilities:
Essential Functions:
ØReviews all hospital and skilled nursing facility admissions for medical necessity and appropriateness in accordance with SCHN policies.
ØMonitors all inpatient stays for continued need and appropriate level of care.
ØCoordinates discharge planning for all hospitalized members by facilitating hospital discharge plans with hospital and/or skilled nursing facility staff.
ØIdentifies and refers members to other agencies/programs such as ALTCS, DDD, CRS, when appropriate as well as identifies and refers members for COB/TPL when appropriate.
ØRepresents SCHN, as a resource person for, and liaison between, physicians, hospital/skilled nursing facility staff and SCHN.
ØParticipates in quality assurance activities in accordance with SCHN policy.
ØMaintains appropriate documentation in accordance with SCHN policy.
ØParticipates in the twenty-four hour coverage of hospital admission reviews/authorization to provide clinical expertise and judgment to authorization technician.
ØIdentifies/refers members to Case Management/Disease Management as necessary and participates with case managers in the development of workable solutions.
ØCollects and tracks data as requested by SCHN management.
ØParticipates in special projects as requested by the CRN Supervisor and/or Concurrent Review Manager.
ØAssists in new employee orientation as requested.
ØAttends in-service presentations and assists in identifying areas of needed continuing education.
ØPerforms other duties, assignments and responsibilities as assigned or required.
Secondary Functions:
ØWorks in a manner that is not disruptive to peers, supervisors and/or subordinates.
ØMust maintain regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
ØMust be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.
ØMust be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs.
REQUIREMENTS
Knowledge and Skills:
ØAddition, subtraction, multiplication’s, division, fractions, ratios, decimals, percentages, graphs
ØCreative course of action - must be able to conceive new/innovative ideas or solutions.
ØRequires good decision-making skills with logical thinking using good judgment.
ØCommunicates, writes, advises and counsels on extremely complex matters in a tactful manner
ØPersonal Computer, Laptop Computer, Calculator

Education and Work Experience:
ØR.N. Bachelor's Degree preferred
ØThree years clinical/hospital nursing experience, such as ICU, OB/Maternity, Med/Surgical, etc. Prior concurrent review experience with a health plan preferred


Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k)
* Tuition reimbursement
Visit www.schalleranderson.com for more information or submit a resume to [Click here for email]. EOE