Florida Licensed Concurrent Review Nurse

Job Summary

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

Key Responsibilities

• Perform concurrent reviews to assess member health and determine appropriate level of care
• Review quality and continuity of care, including acuity level, resource consumption, and discharge planning
• Collaborate with healthcare providers and leadership to improve care quality and ensure compliance with policies

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
• Active compact nursing license or RN license for Health Net of California
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred