Louisiana Licensed Clinical Review Nurse
Job Summary
Supporting the Ambetter team, the full-time Louisiana Licensed Clinical Review Nurse will perform clinical and concurrent medical necessity reviews, working remotely with a schedule of Monday to Friday, 8:00 a.m. to 5:00 p.m., including a weekend rotation every 4th or 5th weekend and a weekday flex day.
Key responsibilities:
- Conduct concurrent reviews to assess members' overall health and appropriate level of care
- Collaborate with Medical Affairs and healthcare providers to evaluate care delivery and approve medical determinations
- Document concurrent review findings and maintain accurate medical records in compliance 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 at least 2 years of acute care experience
- Knowledge of Medicare and Medicaid regulations preferred
- Understanding of utilization management processes preferred
- Current Louisiana nursing license or willingness to obtain compact licensure
Complete Job Description
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