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Concurrent Review Nurse

Leon Medical Centers • Miami, FL, US • published 2026-10-03 09:13:43.221850

Description

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high\-quality, and cost\-effective care. This is achieved through the review of inpatient admissions, outpatient precertification, and prior authorization requests, using established medical policies, evidence\-based guidelines, and managed care standards. ### **Essential Duties and Responsibilities** * Lead, train, and support both clinical and non\-clinical staff in accordance with Leon Health’s policies and procedures to ensure efficient and effective performance. * Monitor and respond to incoming calls and written inquiries from members, providers, and internal departments. * Oversee the quality, accuracy, and timeliness of prior authorization reviews and ensure appropriate prioritization. * Enter service requests and determination data into the appropriate systems in compliance with regulatory requirements and organizational policies. * Review clinical documentation for precertification and concurrent (ongoing) reviews. * Perform on\-site and/or telephonic reviews to determine the appropriateness of inpatient and outpati...

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