New York Licensed Clinical Review Nurse

Job Summary

To support healthcare delivery, the full-time New York Licensed Clinical Review Nurse will perform concurrent reviews to determine members' overall health, evaluate medical necessity, and assist in discharge planning, all while working remotely from New York.

Key responsibilities

• Conduct concurrent reviews to assess the appropriateness of care and setting for members
• Collaborate with Medical Affairs and healthcare providers to validate care delivery and approve medical determinations
• Document findings and maintain records in health management systems according to utilization management policies

Required qualifications

• Bachelor's degree in Nursing (BSN) or graduation from an accredited nursing program
• Active and unrestricted New York State Registered Nurse (RN) license preferred
• 2 to 4 years of related clinical experience
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred