Florida Licensed Clinical Review Nurse

Job Summary

Conducting inpatient concurrent reviews, the full-time Florida Licensed Clinical Review Nurse will assess medical necessity using InterQual criteria and corporate policies while working remotely and providing weekend and holiday coverage as needed.

Key responsibilities

• Performs concurrent reviews to evaluate member health and determine appropriate care levels
• Collaborates with healthcare providers and Medical Affairs to ensure quality care and timely discharges
• Documents review findings and provides education on utilization processes to enhance care quality

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
• Knowledge of Medicare and Medicaid regulations preferred
• Understanding of utilization management processes preferred
• Current state licensure as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) required