California Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Perform concurrent reviews to evaluate member health and determine appropriate care levels
• Review quality and continuity of care, including discharge planning and resource consumption
• Collaborate with healthcare providers and leadership to improve care quality and compliance with guidelines

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 at least 2 years in acute care
• California RN license required
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred