To support healthcare delivery, the full-time North Carolina Licensed Clinical Review Nurse will perform concurrent reviews to assess members' overall health, evaluate medical necessity, and contribute to discharge planning while working remotely. Key responsibilities Conduct concurrent reviews to determine the appropriateness of care and setting for members Collaborate with Medical Affairs and healthcare providers to validate medical determinations and improve care quality Document concurrent review findings and assist in discharge planning to ensure timely transitions between care levels Required qualifications 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 Knowledge of Medicare and Medicaid regulations preferred Familiarity with utilization management processes preferred
Clinical Review Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.