Kentucky Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Performs concurrent reviews to determine member's overall health and appropriate level of care
• Reviews quality and continuity of care, including acuity level and discharge planning
• Collaborates with healthcare providers and Medical Affairs to discuss member care and approve medical determinations

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, with 2+ years in acute care
• KY or Compact State Licensure as an LPN or RN required
• Clinical knowledge to determine overall health and treatment needs preferred
• Knowledge of Medicare and Medicaid regulations preferred