Nevada Licensed Clinical Care Reviewer

Job Summary

To support healthcare service delivery, the full-time Nevada Licensed Clinical Care Reviewer will process medical necessity reviews, assist with discharge planning, and coordinate care for members while working remotely.

Key responsibilities:

• Complete prospective, concurrent, and retrospective reviews for various healthcare services and procedures
• Engage with care partners and medical directors to facilitate appropriate transitions of care
• Identify quality issues and refer members for Care Management as needed

Required qualifications:

• Current, unrestricted Registered Nurse (RN) Licensure in the state of practice
• Associate of Science (A.S) from an accredited registered nursing degree program
• Three years of clinical experience, preferably in med/surgical, emergency acute care, or home health
• Experience in Utilization Management/Utilization Review is preferred
• Knowledge of Medicaid, Medicare, or commercial healthcare systems is preferred