Mississippi Licensed Clinical Review Nurse

Job Summary

Supporting the Utilization Management team, the full-time Mississippi Licensed Clinical Review Nurse will perform concurrent reviews to assess medical necessity and overall health of members, ensuring appropriate levels of care while working remotely.

Key responsibilities

• Conduct concurrent reviews to evaluate the appropriateness of care and discharge planning for members
• Collaborate with healthcare providers and Medical Affairs to discuss member care and approve 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, including 2+ years of acute care experience
• Knowledge of Medicare and Medicaid regulations preferred
• Understanding of utilization management processes preferred
• Current Mississippi nursing license (LPN or RN) required