Illinois Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Perform concurrent reviews to determine overall health and appropriate level of care for members
• Review quality and continuity of care, including acuity level and discharge planning
• Collaborate with healthcare providers and Medical Affairs to validate care delivery and provide educational support on utilization processes

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, with at least 2 years in acute care
• Active Illinois RN license preferred
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred