Supporting the Ambetter marketplace members in Georgia, the full-time remote Georgia Licensed Clinical Review Nurse will perform concurrent reviews to evaluate members' overall health, assess the necessity of care, and contribute to discharge planning according to established guidelines. Key responsibilities Conduct concurrent reviews to determine appropriate care and setting for members Collaborate with Medical Affairs and healthcare providers to validate care delivery and approve medical determinations Document and maintain findings in health management systems in compliance with utilization management policies Required qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience, including 2+ years of acute care experience Current Georgia RN state licensure or Compact RN licensure Knowledge of Medicare and Medicaid regulations preferred Familiarity with utilization management processes preferred
Georgia Licensed Clinical Review Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.