New York Licensed Clinical Review Nurse

Job Summary

A company is looking for a Clinical Review Nurse - Concurrent Review.

Key Responsibilities

• Performs concurrent reviews to determine overall health and appropriate level of care for members
• Reviews quality and continuity of care, including acuity level and discharge planning
• Collaborates with healthcare providers and leadership to improve care quality and medically necessary services

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, with 2+ years in acute care required
• Active New York State nursing license required
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred