Supporting Illinois Medicaid and Ambetter utilization management, the full-time Illinois Licensed Clinical Review Nurse will perform concurrent reviews to evaluate member health, assess medical necessity, and contribute to discharge planning while working remotely from home. Key responsibilities: Conducts concurrent reviews to determine the appropriateness of care and setting for members Collaborates with Medical Affairs and healthcare providers to discuss care delivery and approve medical determinations Documents review findings and maintains accurate member medical records 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 Illinois RN licensure is required Knowledge of Medicare and Medicaid regulations is preferred Familiarity with utilization management processes is preferred
Illinois Licensed Clinical Review Nurse in workfromhome at Unknown Company
This position is listed as part time and able to be worked remotely.