California Licensed Concurrent Review Nurse

Job Summary

A company is looking for a Concurrent Review Nurse, LVN/LPN (Work from Home).

Key Responsibilities:

• Conduct timely reviews of inpatient and skilled nursing services to determine medical necessity and appropriateness
• Collaborate with the Medical Director on complex cases and provide comprehensive clinical summaries
• Process authorization requests and ensure timely communication with healthcare providers and payers

Qualifications:

• Licensed Vocational/Practical Nurse (LVN/LPN) with an active California nursing license; BSN preferred
• Minimum of 2-3 years of clinical nursing experience, including at least 1 year in utilization review or case management
• Preferred certifications: Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), or Accredited Case Manager (ACM)
• Strong knowledge of clinical guidelines and medical necessity criteria
• Proficiency in electronic health records (EHR) and utilization management software