Arizona Licensed Clinical Review Nurse

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

Key Responsibilities

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

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

Collaborates with healthcare providers and Medical Affairs to ensure appropriate care and medical determinations

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

Licensed Practical Nurse (LPN) or Registered Nurse (RN) license required

Clinical knowledge to assess member health and treatment needs preferred

Knowledge of Medicare and Medicaid regulations and utilization management processes preferred