Nevada Licensed Clinical Review Nurse

Job Summary

Working remotely on a full-time basis, the Nevada Licensed Clinical Review Nurse will perform concurrent reviews to assess member health, evaluate medical necessity, and contribute to discharge planning for inpatient services.

Key responsibilities

• Conduct concurrent reviews to determine the appropriateness of care and setting for members
• Collaborate with healthcare providers and Medical Affairs to discuss and approve medical determinations based on review findings
• Document and maintain concurrent review findings and discharge plans in health management systems according to utilization management policies

Required qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, with a minimum of 2 years in acute care
• RN licensure in the state of Nevada or ability to obtain compact state licensure
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred