Licensed Clinical Review Nurse

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 discharge planning and resource consumption • Collaborates with healthcare providers and medical directors to discuss member care and provides education on utilization processes 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 at least 2 years in acute care • Licensed Practical Nurse (LPN) state licensure required; Registered Nurse (RN) preferred • Clinical knowledge to determine member health and treatment needs preferred • Knowledge of Medicare and Medicaid regulations and utilization management processes preferred