State Licensed NICU Nurse

Job Summary

To support clinical operations, the full-time State Licensed NICU Nurse will manage member care coordination, including pre-admission processes, concurrent reviews, and discharge planning, all while working remotely.

Key responsibilities:

• Initiating the continuum of care process for neonatal admissions
• Interacting with hospital staff to collect clinical information for medical necessity determinations
• Coordinating discharge planning needs for newborns being discharged from intensive care nurseries

Required qualifications:

• Registered Nurse (RN) with a current, unrestricted license
• Three or more years of clinical experience as a nurse in a Level III or Level IV NICU
• Three or more years of experience in concurrent review or discharge planning within a health plan or acute facility (strongly preferred)
• Experience with Interqual and/or MCG is preferred
• Experience with data entry into a database or EHR required