TX Licensed Clinical Review Nurse

Job Summary

Working remotely in the Central Time Zone, the full-time salaried TX Licensed Clinical Review Nurse will perform concurrent reviews to assess members' health and care needs, collaborating with healthcare teams and documenting findings in health management systems.

Key responsibilities

• Conduct concurrent reviews to evaluate members' overall health, care appropriateness, and discharge planning
• Collaborate with Medical Affairs and care management teams to ensure quality and continuity of care
• Document findings and educate providers on utilization processes while providing feedback to leadership

Required qualifications

• High school diploma with an associate degree or higher in nursing
• Compact nursing license as an RN, LPN, or LVN is required
• Graduation from an accredited nursing program is preferred
• One or more years of nursing experience is required; two or more years of acute care experience is preferred
• Experience with Medicaid and managed care organizations is preferred