Nevada Licensed Clinical Review Nurse

To support the evaluation of member care, the full-time Nevada Licensed Clinical Review Nurse will perform concurrent reviews, assess medical necessity, and contribute to discharge planning in a remote work environment with a Monday-Friday schedule, including rotational weekends and holidays. Key responsibilities Conduct concurrent reviews to determine the appropriateness of care and overall health of members Collaborate with Medical Affairs and healthcare providers to discuss care delivery and approve medical determinations Document 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, including 2+ years of acute care experience Current RN licensure in the state of Nevada or ability to obtain compact state licensure Experience in neonatal level II or IV NICU is preferred; NICU certification is a plus Knowledge of Medicare and Medicaid regulations and utilization management processes preferred