Missouri Licensed Clinical Review Nurse

To support healthcare delivery, the full-time Missouri Licensed Clinical Review Nurse will perform concurrent reviews to evaluate members' overall health, assess the appropriateness of care, and contribute to discharge planning in a remote setting. Key responsibilities: Conducts concurrent reviews to determine the appropriateness of care and setting for members Collaborates with Medical Affairs and healthcare providers to discuss and approve medical determinations based on review findings Documents and maintains findings, discharge plans, and actions taken in health management systems according to utilization management policies Required qualifications: Active, unrestricted Compact RN License Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2+ years of acute care nursing experience Experience in Utilization Management (UM), Utilization Review (UR), Case Management, or Care Management preferred Knowledge of Medicare and Medicaid regulations preferred