Missouri Licensed Clinical Review Nurse

A company is looking for a Clinical Review Nurse - Retrospective Review.

Key Responsibilities

Conducts clinical retrospective reviews of medical records to assess the appropriateness of care and services provided

Identifies quality of care issues and consults with senior management and healthcare providers on discrepancies

Maintains compliance with regulatory guidelines by documenting member clinical information in health management systems

Required Qualifications, Training, and Education

Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing

2 - 4 years of related experience in clinical review or utilization management

Knowledge of Medicare and Medicaid regulations preferred

Knowledge of utilization management processes preferred

LPN - Licensed Practical Nurse - State Licensure required