Job Summary
A company is looking for a Clinical Review Nurse - Concurrent Review.
Key Responsibilities
- Performs concurrent reviews to determine overall health and appropriate level of care for members
- Reviews quality and continuity of care, including acuity level and discharge planning
- Collaborates with healthcare providers and Medical Affairs to approve medical determinations and improve care quality
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 required
- Knowledge of Medicare and Medicaid regulations preferred
- LPN licensure required; RN licensure highly preferred
- Experience in adult, pediatric, maternity, and behavioral health services preferred
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