Florida Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Performs concurrent reviews to assess member health and appropriate level of care
• Reviews quality and continuity of care, including discharge planning and resource utilization
• Collaborates with healthcare providers and leadership to improve care quality and compliance with clinical policies

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
• State Licensure as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) required
• Knowledge of Medicare and Medicaid regulations preferred
• Experience with utilization management processes preferred