Florida Licensed Clinical Review Nurse

Job Summary

To support patient care initiatives, the full-time Florida Licensed Clinical Review Nurse will perform concurrent reviews to assess medical necessity, coordinate discharge planning, and collaborate with healthcare providers while working remotely.

Key responsibilities

• Complete timely inpatient utilization reviews against medical necessity criteria and health plan policies
• Document clinical findings and collaborate with providers and internal teams to facilitate care and discharge planning
• Assist with quality reviews, audits, and compliance activities while managing daily case volume effectively

Required qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, including 2+ years of acute care experience
• Knowledge of Medicare and Medicaid regulations preferred
• Understanding of utilization management processes preferred
• Current Florida nursing license required