Michigan Licensed Clinical Review Nurse

Job Summary

To support Medicaid and Market Place/Ambetter members, the full-time Michigan Licensed Clinical Review Nurse will perform concurrent reviews to evaluate member health, assess the appropriateness of care, and contribute to discharge planning while working remotely from home.

Key responsibilities

• Conduct concurrent reviews to determine overall health and appropriate level of care for members
• Collaborate with Medical Affairs and healthcare providers to validate medical necessity and approve care determinations
• Document and maintain findings, discharge plans, and actions taken in health management systems according to guidelines

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
• Unencumbered compact nursing license and Michigan nursing licensure required
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred