Nurse

• Review inpatient admissions and elective procedures to determine medical necessity
• Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care
• Review acuity level, resource consumption, length of stay, quality, continuity of care, and discharge planning
• Work with Medical Affairs and/or Medical Directors to discuss member care
• Collect, document, and maintain concurrent review findings, discharge plans, and actions in health management systems
• Work with healthcare providers to approve medical determinations or provide recommendations
• Educate providers on utilization processes
• Provide leadership feedback on opportunities to improve level of care and medical necessity
• Review transfer and discharge plans for timely transitions between levels of care and facilities
• Collaborate with care management on member referrals
• Comply with all policies and standards
• Perform other duties as assigned

Clinical Review Nurse – Concurrent Review

• Provide direct patient care, including IV therapy, under the direction of a registered nurse
• Direct and assist ancillary nursing staff with assigned duties
• Interact with the multidisciplinary team and other personnel
• Use the nursing process through data gathering, planning, and evaluation
• Provide care addressing physical, psychosocial, educational, safety, and age-related criteria
• Communicate effectively with patients, guests, family members, and coworkers
• Adapt to changing unit or department needs
• Maintain professional development, clinical knowledge, technical skills, training, and credentials
• Remain knowledgeable about applicable laws, accreditation standards, and regulatory requirements
• Ensure compliance with applicable laws, regulations, and standards
• Report known or suspected unethical conduct and patient, employee safety, privacy, or compliance concerns
• Perform other related duties as required

Nurse jobs in Mississippi

Clinical Review Nurse – Concurrent Review

Licensed Practical Nurse – Virtual Messaging Network