California Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Performs concurrent reviews to assess member health and appropriateness of care
• Evaluates quality and continuity of care, including discharge planning and resource usage
• Collaborates with healthcare providers and leadership to improve care quality and compliance

Required Qualifications

• 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
• RN - Registered Nurse License required
• Clinical knowledge to assess treatment needs and care levels preferred
• Familiarity with Medicare and Medicaid regulations preferred