Concurrent Review Nurse - Multi-State Licensed

Job Summary

Performing concurrent reviews to evaluate member health and care delivery, the full-time Concurrent Review Nurse - Multi-State Licensed will work remotely, assessing medical necessity and contributing to discharge planning while collaborating with healthcare providers and medical directors.

Key responsibilities

• Conducts concurrent reviews to determine the appropriateness of care and setting for members
• Reviews quality and continuity of care, including acuity levels and discharge planning
• Collaborates with healthcare providers to approve medical determinations based on concurrent review findings

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 in acute care
• Active multi-state nursing licensure in good standing
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred