Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Performs concurrent reviews to determine overall health and appropriate level of care for members
• Reviews quality and continuity of care, including discharge planning and resource consumption
• Collaborates with healthcare providers and medical directors to discuss member care and provides education on utilization processes

Required Qualifications, Training, and Education

• 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) state licensure required; Registered Nurse (RN) preferred
• Clinical knowledge to determine member health and treatment needs preferred
• Knowledge of Medicare and Medicaid regulations and utilization management processes preferred