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
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