California Licensed NICU RN

Job Summary

A company is looking for a NICU RN Clinical Review Nurse Concurrent Review.

Key Responsibilities

• Perform concurrent reviews to determine member's overall health and appropriate level of care
• Review quality and continuity of care, including acuity level and discharge planning
• Collaborate with healthcare providers and Medical Affairs on medical determinations and recommendations

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 2+ years in acute care required
• Active nursing licensure required (LPN or RN depending on location)
• Clinical knowledge of treatment needs and appropriate level of care preferred
• Knowledge of Medicare and Medicaid regulations and utilization management processes preferred