Working remotely from Missouri, the full-time Missouri Licensed Clinical Review Nurse will perform concurrent reviews to evaluate members' overall health and the appropriateness of care, ensuring compliance with care policies and guidelines. Key responsibilities Conducts concurrent reviews to assess members' health and the necessity of care provided Collaborates with healthcare providers and Medical Affairs to validate medical determinations and discharge plans Documents findings and maintains medical records in accordance with utilization management policies Required qualifications Active RN licensure in Missouri or compact state licensure 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 Knowledge of Medicare and Medicaid regulations preferred Familiarity with utilization management processes is advantageous
Missouri Licensed Clinical Review Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.