Missouri Licensed Clinical Review Nurse
Job Summary
Working remotely from Missouri, the full-time Missouri Licensed Clinical Review Nurse will perform concurrent reviews to evaluate members' overall health and the appropriateness of care, ensuring compliance with care policies and guidelines.
Key responsibilities
- Conducts concurrent reviews to assess members' health and the necessity of care provided
- Collaborates with healthcare providers and Medical Affairs to validate medical determinations and discharge plans
- Documents findings and maintains medical records in accordance with utilization management policies
Required qualifications
- Active RN licensure in Missouri or compact state licensure
- 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
- Familiarity with utilization management processes is advantageous
Complete Job Description
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