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 member's overall health and appropriate level of care
• Reviews quality and continuity of care, including acuity level, resource consumption, and discharge planning
• Collaborates with healthcare providers and Medical Affairs to discuss member care and ensure compliance with utilization management policies

Required Qualifications, Training, and Education

• Graduation from an accredited school of nursing or a Bachelor's degree in Nursing (BSN)
• 2-4 years of related nursing experience, with a minimum of 2 years in acute care
• Knowledge of Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred
• NYS RN Licensure strongly preferred