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 and discharge planning

Collaborates with healthcare providers and Medical Affairs to discuss member care and approve medical determinations

Required Qualifications

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

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

Compact license is mandatory

Knowledge of Medicare and Medicaid regulations preferred

Familiarity with utilization management processes preferred