Florida Licensed Clinical Review Nurse
Job Summary
To support patient care initiatives, the full-time Florida Licensed Clinical Review Nurse will perform concurrent inpatient utilization reviews, assess medical necessity, and collaborate with healthcare providers while working remotely.
Key responsibilities
- Conduct timely inpatient utilization reviews against medical necessity criteria and health plan policies
- Document clinical findings and coordinate care with providers and internal teams to support discharge planning
- Assist with quality reviews, audits, and compliance activities while managing daily case volume
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
- Current Florida RN license or Compact State Licensure
- Preferred knowledge of Medicare and Medicaid regulations
- Preferred understanding of utilization management processes
Complete Job Description
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