Missouri Licensed Clinical Review Nurse

Job Summary

To support healthcare delivery, the full-time Missouri Licensed Clinical Review Nurse will perform concurrent reviews to evaluate members' overall health, assess the appropriateness of care, and contribute to discharge planning in a remote setting.

Key responsibilities:

• Conducts concurrent reviews to determine the appropriateness of care and setting for members
• Collaborates with Medical Affairs and healthcare providers to discuss and approve medical determinations based on review findings
• Documents and maintains findings, discharge plans, and actions taken in health management systems according to utilization management policies

Required qualifications:

• Active, unrestricted Compact RN License
• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2+ years of acute care nursing experience
• Experience in Utilization Management (UM), Utilization Review (UR), Case Management, or Care Management preferred
• Knowledge of Medicare and Medicaid regulations preferred