Nevada Licensed Clinical Review Nurse

Job Summary

To support the evaluation of member care, the full-time Nevada Licensed Clinical Review Nurse will perform concurrent reviews, assess medical necessity, and contribute to discharge planning in a remote work environment with a Monday-Friday schedule, including rotational weekends and holidays.

Key responsibilities

• Conduct concurrent reviews to determine the appropriateness of care and overall health of members
• Collaborate with Medical Affairs and healthcare providers to discuss care delivery and approve medical determinations
• Document findings and maintain accurate medical records in compliance with utilization management policies

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 RN licensure in the state of Nevada or ability to obtain compact state licensure
• Experience in neonatal level II or IV NICU is preferred; NICU certification is a plus
• Knowledge of Medicare and Medicaid regulations and utilization management processes preferred