Licensed Clinical 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 care levels
• Review quality and continuity of care, including discharge planning and resource utilization
• Collaborate with healthcare providers and medical directors to ensure appropriate care delivery

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
• Licensed Practical Nurse (LPN) or Registered Nurse (RN) license required
• Clinical knowledge to assess member health and treatment needs preferred
• Knowledge of Medicare and Medicaid regulations preferred