Nevada Licensed Clinical Review Nurse

Job Summary

To support Medicaid and Market Place/Ambetter members, the full-time Nevada Licensed Clinical Review Nurse will perform concurrent reviews to assess members' overall health and the appropriateness of care while working remotely from home.

Key responsibilities:

• Conduct concurrent reviews to determine the appropriateness of care and setting for members
• Collaborate with Medical Affairs and healthcare providers to discuss and approve medical determinations
• Document findings and maintain member medical records 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 nursing experience, including 2+ years of acute care experience
• Current RN licensure in the state of Nevada or compact state licensure
• Experience in LTACH, IPR, or SNF settings preferred
• Knowledge of Medicare and Medicaid regulations and utilization management processes preferred