Missouri and Kansas Licensed Clinical Review Nurse

Job Summary

Utilizing a collaborative review process, the full-time Missouri and Kansas Licensed Clinical Review Nurse will conduct utilization management reviews, ensuring appropriate healthcare system use while advocating for members and providers in a remote work environment.

Key responsibilities

• Conduct pre-service, concurrent, and post-service utilization management reviews to assess medical necessity and benefits
• Review medical information to determine eligibility and reimbursement for services, referring cases as necessary to the Medical Director
• Communicate effectively with team members and stakeholders to educate and assess members and providers, maximizing healthcare outcomes

Required qualifications

• Associate degree in nursing
• 3+ years of full-time direct patient care clinical experience in medical/surgical, pediatrics, and/or obstetrics
• RN license in Missouri and Kansas
• Proven experience in problem definition and data collection to solve practical problems
• Experience effectively presenting information to groups of managers, clients, and the public