Supporting the Ambetter team, the full-time Louisiana Licensed Clinical Review Nurse will perform clinical and concurrent medical necessity reviews, working remotely with a schedule of Monday to Friday, 8:00 a.m. to 5:00 p.m., including a weekend rotation every 4th or 5th weekend and a weekday flex day. Key responsibilities: Conduct concurrent reviews to assess members' overall health and appropriate level of care Collaborate with Medical Affairs and healthcare providers to evaluate care delivery and approve medical determinations Document concurrent review findings and maintain accurate 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, with at least 2 years of acute care experience Knowledge of Medicare and Medicaid regulations preferred Understanding of utilization management processes preferred Current Louisiana nursing license or willingness to obtain compact licensure
Louisiana Licensed Clinical Review Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.