California Licensed Clinical Review Nurse

Job Summary

Working remotely on a full-time basis, the California Licensed Clinical Review Nurse will perform concurrent reviews to assess members' overall health, evaluate the necessity of care, and contribute to discharge planning while adhering to care policies and guidelines.

Key responsibilities

• Conducts concurrent reviews to determine the appropriate level of care and overall health of members
• Collaborates with Medical Affairs and healthcare providers to discuss and approve medical determinations based on review findings
• Documents and maintains concurrent review findings and discharge plans in health management systems according to utilization management policies

Required qualifications

• Active RN license in California
• 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
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred