State Licensed Clinical Review Nurse

To support patient care coordination, the full-time State Licensed Clinical Review Nurse will perform concurrent reviews of inpatient services, assess medical necessity, and collaborate with healthcare providers, all while working remotely. Key responsibilities Conduct timely inpatient utilization reviews against medical necessity criteria and health plan policies Document clinical findings and collaborate with providers to support discharge planning and care coordination Assist with quality reviews, audits, and compliance activities while managing daily case volume and productivity expectations 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 State Licensure as a Registered Nurse or Licensed Practical Nurse required Preferred knowledge of Medicare and Medicaid regulations Familiarity with utilization management processes preferred