North Carolina Licensed Clinical Review Nurse
Job Summary
To support healthcare delivery, the full-time North Carolina Licensed Clinical Review Nurse will perform concurrent reviews to assess members' overall health, evaluate medical necessity, and contribute to discharge planning while working remotely.
Key responsibilities
- Conduct concurrent reviews to determine the appropriateness of care and setting for members
- Collaborate with Medical Affairs and healthcare providers to validate medical determinations and improve care quality
- Document concurrent review findings and assist in discharge planning to ensure timely transitions between care levels
Required qualifications
- Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
- 2 - 4 years of related experience, with at least 2 years in acute care
- Licensed Practical Nurse (LPN) state licensure required
- Knowledge of Medicare and Medicaid regulations preferred
- Familiarity with utilization management processes preferred
Complete Job Description
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