Licensed Clinical Review Nurse

A company is looking for a Clinical Review Nurse - Concurrent Review. Key Responsibilities Performs concurrent reviews to determine overall health and appropriate level of care for members Reviews quality and continuity of care, including discharge planning and resource consumption Collaborates with healthcare providers and medical directors to discuss member care and provides education on utilization processes Required Qualifications, Training, and Education Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience, with at least 2 years in acute care Licensed Practical Nurse (LPN) state licensure required; Registered Nurse (RN) preferred Clinical knowledge to determine member health and treatment needs preferred Knowledge of Medicare and Medicaid regulations and utilization management processes preferred

Created: 2026-03-05