Missouri Licensed Clinical Review Nurse

Job Summary

Performing concurrent reviews to assess member health and care appropriateness, the full-time Missouri Licensed Clinical Review Nurse will evaluate medical necessity, collaborate with healthcare providers, and contribute to discharge planning in a remote setting.

Key responsibilities

• Conduct concurrent reviews to determine overall health and appropriate care levels for members
• Document and maintain findings, discharge plans, and actions taken in health management systems
• Collaborate with Medical Affairs and healthcare providers to discuss care delivery and approve medical determinations

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
• Current Missouri RN Licensure or Compact State Licensure
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred