North Carolina 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 and discharge planning
• Collaborates with healthcare providers and Medical Affairs to discuss member care and approve medical determinations

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
• Knowledge of Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred
• LPN or RN license required, depending on the state