Nevada Licensed Clinical Review Nurse

A company is looking for a Clinical Review Nurse - Concurrent Review.

Key Responsibilities

Performs concurrent reviews of members to assess overall health and appropriate level of care

Reviews quality and continuity of care, including acuity levels, resource consumption, and discharge planning

Collaborates with healthcare providers and Medical Affairs to validate medical determinations and improve care quality

Required Qualifications, Training, and Education

Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing

2 - 4 years of related experience, with 2+ years in acute care required

LPN or RN license in Nevada is required

Knowledge of Medicare and Medicaid regulations preferred

Familiarity with utilization management processes preferred