California Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Conducts clinical retrospective reviews of medical records to assess the appropriateness of care and services provided
• Identifies quality of care issues and collaborates with senior management and healthcare providers for resolution
• Maintains compliance with regulatory guidelines by documenting and managing member clinical information

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience in clinical review or nursing
• Clinical knowledge and ability to analyze medical records preferred
• Knowledge of Medicare and Medicaid regulations preferred
• RN license required for Health Net of California