California Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Performs concurrent reviews to determine members' overall health and appropriate level of care
• Reviews quality and continuity of care, including acuity level and discharge planning
• Collaborates with healthcare providers and leadership to improve care quality and ensure timely discharges

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, including 2+ years of acute care experience
• Active RN license required for Health Net of California
• Clinical knowledge to assess treatment needs and appropriate levels of care preferred
• Knowledge of Medicare and Medicaid regulations and utilization management processes preferred