New York Licensed Clinical Review Nurse

Job Summary

Working remotely on a full-time basis, the New York Licensed Clinical Review Nurse will perform concurrent reviews to assess member health, evaluate medical necessity, and contribute to discharge planning while collaborating with healthcare providers and medical directors.

Key responsibilities

• Conduct concurrent reviews to determine the overall health and appropriate level of care for members
• Evaluate the quality and continuity of care, including discharge planning and resource utilization
• Document findings and collaborate with medical professionals to ensure adherence to utilization management policies

Required qualifications

• Active and unrestricted New York State Registered Nurse (RN) licensure
• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2+ years of acute care experience
• Clinical knowledge to assess treatment needs and appropriate levels of care
• Familiarity with Medicare and Medicaid regulations is preferred