California Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Performs concurrent reviews to assess member health and appropriate level of care
• Evaluates quality and continuity of care, including discharge planning and resource consumption
• Collaborates with healthcare providers and leadership to improve care quality and compliance with clinical guidelines

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, with at least 2 years of acute care experience
• RN license required, must be licensed in California
• Clinical knowledge to assess member health and treatment needs preferred
• Knowledge of Medicare and Medicaid regulations and utilization management processes preferred