RN Clinical Review Nurse

A company is looking for a Clinical Review Nurse - Concurrent Review - RN. Key Responsibilities Performs concurrent reviews to determine overall health and appropriate level of care for members Reviews quality and continuity of care, including acuity level and discharge planning Collaborates with healthcare providers and Medical Affairs to discuss member care and validate medical necessity 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 of acute care experience required RN Compact/Multi-State License required; LPN State Licensure also required Clinical knowledge to determine treatment needs and appropriate level of care preferred Knowledge of Medicare and Medicaid regulations and utilization management processes preferred

May 20, 2025 - 19:30

A company is looking for a Clinical Review Nurse - Concurrent Review - RN. Key Responsibilities Performs concurrent reviews to determine overall health and appropriate level of care for members Reviews quality and continuity of care, including acuity level and discharge planning Collaborates with healthcare providers and Medical Affairs to discuss member care and validate medical necessity 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 of acute care experience required RN Compact/Multi-State License required; LPN State Licensure also required Clinical knowledge to determine treatment needs and appropriate level of care preferred Knowledge of Medicare and Medicaid regulations and utilization management processes preferred