Nevada Licensed Clinical Review Nurse

Job Summary

To support NICU care, the full-time Nevada Licensed Clinical Review Nurse will perform concurrent reviews to assess member health, evaluate medical necessity, and contribute to discharge planning while working remotely from home.

Key responsibilities

• Conducts concurrent reviews to determine overall health and appropriate level of care for members
• Collaborates with Medical Affairs and healthcare providers to discuss care delivery and approve medical determinations
• Maintains documentation of review findings and discharge plans in health management systems according to utilization management guidelines

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 Nevada or ability to achieve licensure in non-compact states
• Knowledge of Medicare and Medicaid regulations preferred
• NICU certification is helpful