Licensed Clinical Review Nurse

Job Summary

Performing concurrent reviews to assess members' health and care needs, the full-time Licensed Clinical Review Nurse will evaluate medical necessity, collaborate with healthcare providers, and contribute to discharge planning in a remote setting.

Key responsibilities

• Conduct concurrent reviews to determine the appropriateness of care and setting for members
• Collaborate with Medical Affairs and healthcare providers to discuss and validate care delivery and medical determinations
• Document findings and maintain member medical records in accordance with utilization management policies

Required qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, with a minimum of 2 years in acute care
• Licensed Practical Nurse (LPN) or Registered Nurse (RN) state licensure required
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred