WA Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Performs concurrent reviews to assess member health and appropriate level of care
• Reviews quality and continuity of care, including discharge planning and resource consumption
• Collaborates with healthcare providers and leadership to improve care quality and compliance with guidelines

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 a minimum of 2 years in acute care
• Active compact RN license required
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred