Senior Clinical Review Nurse - Concurrent Review

Job Summary

A company is looking for a Senior Clinical Review Nurse - Concurrent Review.

Key Responsibilities:

• Perform complex concurrent reviews of members for appropriate care and setting
• Review and assess quality and continuity of care, discharge planning, and transfer plans
• Collaborate with healthcare providers, leadership, and care management to ensure high-quality care

Required Qualifications:

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 4-6 years of related experience with 2+ years of acute care experience
• Licensed Practical Nurse (LPN) - State Licensure required, RN preferred
• Advanced clinical knowledge and understanding of Medicare and Medicaid regulations preferred
• Strong knowledge of utilization management processes preferred