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Licensed Clinical Review Nurse

February 28, 2026

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

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