North Carolina Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Perform concurrent reviews to determine members' overall health and appropriate level of care
• Review quality and continuity of care, including acuity level, resource consumption, and discharge planning
• Collaborate with healthcare providers and leadership to improve care quality and ensure compliance with utilization management policies

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, including 2+ years of acute care experience
• Active LPN or RN licensure in North Carolina or a compact RN/LPN credential from another state
• Clinical knowledge to assess members' health and treatment needs
• Knowledge of Medicare and Medicaid regulations and utilization management processes preferred