California Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Perform concurrent reviews to assess member health and appropriate care setting
• Review quality and continuity of care, including discharge planning and resource utilization
• Collaborate with healthcare providers and leadership to improve care quality and compliance

Required Qualifications, Training, and Education

• Active California Registered Nurse license required
• 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 preferred
• Clinical knowledge to assess treatment needs and care levels preferred
• Familiarity with Medicare and Medicaid regulations preferred