Concurrent Review Nurse

Position Summary:

• The Concurrent Review Nurse is responsible for performing utilization management activities to ensure medical services are delivered effectively, efficiently, and appropriately.


• This includes reviewing inpatient admissions and ongoing hospital stays to determine medical necessity, appropriateness of care, and length of stay in accordance with clinical guidelines and payer requirements.

Key Responsibilities:

• Conduct timely and accurate concurrent reviews of inpatient hospitalizations and other levels of care.


• Evaluate clinical documentation against evidence-based criteria (e.g., InterQual®, MCG) to determine medical necessity and appropriate level of care.
• Collaborate with physicians, hospital staff, and insurance companies to coordinate patient care and discharge planning.
• Communicate utilization review decisions and recommendations to providers and payers.
• Do...