Licensed Concurrent Review Nurse

Job Summary

A company is looking for a Concurrent Review Nurse to perform inpatient reviews and support the Ambetter Marketplace.

Key Responsibilities

• Conducts concurrent reviews to assess member health and appropriateness of care
• Evaluates quality and continuity of care, including discharge planning
• Collaborates with healthcare providers and medical directors on care determinations

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 nursing license (LPN) required
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred