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 assess member health and appropriateness of care
• Review quality and continuity of care, including discharge planning and resource consumption
• Collaborate with healthcare providers and leadership to improve care quality and compliance with clinical 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, with 2+ years in acute care
• Licensed Practical Nurse (LPN) state licensure required
• Clinical knowledge to assess member health and treatment needs preferred
• Familiarity with Medicare and Medicaid regulations and utilization management processes preferred