California Licensed Clinical Review Nurse

Job Summary

Conducting concurrent reviews for inpatient medical admissions, the full-time California Licensed Clinical Review Nurse will evaluate member health, assess care delivery, and contribute to discharge planning in a remote setting.

Key responsibilities

• Performs concurrent reviews to determine appropriate care and setting for members
• Reviews quality and continuity of care, including acuity level and discharge planning
• Collaborates with healthcare providers and Medical Affairs to validate medical determinations

Required qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, with a minimum of 2 years in acute care
• Current RN or LPN state licensure required
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred