Performing concurrent reviews to assess members' health and care needs, the full-time Licensed Clinical Review Nurse will evaluate medical necessity, collaborate with healthcare providers, and contribute to discharge planning in a remote setting. Key responsibilities Conduct concurrent reviews to determine the appropriateness of care and setting for members Collaborate with Medical Affairs and healthcare providers to discuss and validate care delivery and medical determinations Document findings and maintain member medical records in accordance 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, with a minimum of 2 years in acute care Licensed Practical Nurse (LPN) or Registered Nurse (RN) state licensure required Knowledge of Medicare and Medicaid regulations preferred Familiarity with utilization management processes preferred
Licensed Clinical Review Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.