Compact Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Performs concurrent reviews to determine member's overall health and appropriate level of care
• Reviews quality and continuity of care, including acuity level, resource consumption, and discharge planning
• Collaborates with healthcare providers and Medical Affairs to validate medical determinations and improve care quality

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 of acute care experience required
• Licensed Practical Nurse (LPN) state licensure required
• Clinical knowledge to assess member health and treatment needs preferred
• Knowledge of Medicare and Medicaid regulations and utilization management processes preferred