RN Clinical Review Nurse

Job Summary

A company is looking for a Clinical Review Nurse - Concurrent Review - RN.

Key Responsibilities

• Performs concurrent reviews to determine overall health and appropriate level of care for members
• Reviews quality and continuity of care, including acuity level and discharge planning
• Collaborates with healthcare providers and Medical Affairs to discuss member care and validate medical necessity

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 of acute care experience required
• RN Compact/Multi-State License required; LPN State Licensure also required
• Clinical knowledge to determine treatment needs and appropriate level of care preferred
• Knowledge of Medicare and Medicaid regulations and utilization management processes preferred