North Carolina Licensed Clinical Review Nurse
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Job Summary
To support healthcare delivery, the full-time North Carolina Licensed Clinical Review Nurse will perform concurrent reviews to assess member health, evaluate medical necessity, and contribute to discharge planning while working remotely Monday through Friday with a rotating weekend schedule.
Key responsibilities
- Conducts concurrent reviews to determine appropriate care levels and member health status
- Collaborates with Medical Affairs and healthcare providers to discuss care delivery and approve medical determinations
- Documents review findings and discharge plans in health management systems according to utilization management policies
Required qualifications
- Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
- 2+ years of acute care nursing experience required
- Previous experience in Utilization Management (UM) and/or Case Management (CM) preferred
- Knowledge of Medicare and Medicaid regulations preferred
- Current North Carolina RN or LPN licensure required
Complete Job Description
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