Job Summary
A company is looking for a Clinical Review Nurse - Concurrent Review.
Key Responsibilities
- Performs concurrent reviews to assess member's health and appropriateness of care
- Reviews quality and continuity of care, including discharge planning and resource utilization
- Collaborates with healthcare providers and assists in educating them on utilization processes
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 2+ years in acute care
- Knowledge of Medicare and Medicaid regulations preferred
- Knowledge of utilization management processes preferred
- LPN or RN license required, depending on the state
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