Oregon Licensed Clinical Review Nurse

Job Summary

To support the Health Plan in Oregon, the full-time Oregon Licensed Clinical Review Nurse will perform concurrent reviews to evaluate member health, assess the necessity of care, and contribute to discharge planning, all while working remotely.

Key responsibilities

• Conduct concurrent reviews to determine overall health and appropriate care levels for members
• Collaborate with Medical Affairs and healthcare providers to discuss care delivery and approve medical determinations
• Document review findings and discharge plans in health management systems in accordance with utilization management policies

Required qualifications

• 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 Oregon RN License or willingness to obtain one
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred