Compact Licensed Clinical Review Nurse

A company is looking for a Clinical Review Nurse - Concurrent Review. Key Responsibilities Perform concurrent reviews to assess member health and evaluate medical necessity of care Assist in discharge planning and validate necessity and setting of inpatient services Ensure compliance with care policies and guidelines 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 Compact Licensure required; RN license required for Health Net of California Clinical knowledge to assess member health and treatment needs preferred Familiarity with Medicare and Medicaid regulations and utilization management processes preferred

Mar 25, 2025 - 17:08

A company is looking for a Clinical Review Nurse - Concurrent Review. Key Responsibilities Perform concurrent reviews to assess member health and evaluate medical necessity of care Assist in discharge planning and validate necessity and setting of inpatient services Ensure compliance with care policies and guidelines 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 Compact Licensure required; RN license required for Health Net of California Clinical knowledge to assess member health and treatment needs preferred Familiarity with Medicare and Medicaid regulations and utilization management processes preferred