State Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Perform concurrent reviews to determine member's overall health and appropriate level of care
• Review quality and continuity of care, including acuity level and discharge planning
• Collaborate with healthcare providers and leadership to improve care quality and compliance with policies

Required Qualifications

• 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
• Active LPN or RN licensure required
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred