State Licensed Clinical Review Nurse

Job Summary

To support patient care coordination, the full-time State Licensed Clinical Review Nurse will perform concurrent reviews of inpatient services, assess medical necessity, and collaborate with healthcare providers, all while working remotely.

Key responsibilities

• Conduct timely inpatient utilization reviews against medical necessity criteria and health plan policies
• Document clinical findings and collaborate with providers to support discharge planning and care coordination
• Assist with quality reviews, audits, and compliance activities while managing daily case volume and productivity expectations

Required qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2-4 years of related experience, with a minimum of 2 years in acute care
• State Licensure as a Registered Nurse or Licensed Practical Nurse required
• Preferred knowledge of Medicare and Medicaid regulations
• Familiarity with utilization management processes preferred