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 members' overall health, evaluate the necessity of care delivered, and contribute to discharge planning while adhering to care policies and guidelines.

Key responsibilities

• Conducts concurrent reviews to determine appropriate care and setting for members
• Collaborates with healthcare providers and Medical Affairs to discuss care delivery and approve medical determinations
• Documents 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
• Current RN licensure or Compact State Licensure for the state of Nevada
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred