Clinical Review Nurse
2 days ago
We are seeking a highly skilled Clinical Review Nurse to join our team at LanceSoft. As a key member of our healthcare team, you will be responsible for conducting thorough medical necessity reviews of post-acute care services to ensure that patients receive the most appropriate care.
Key Responsibilities- Conduct prospective, concurrent, and retrospective medical necessity reviews of post-acute care services
- Use established medical policy and guidelines to ensure medical necessity for appropriate setting and length of stay
- Coordinate care through the healthcare continuum, including member outreach and support
- Formulate discharge readiness for members transitioning from post-acute care to a lower level of care
- Collaborate with healthcare providers, facilities, and members to ensure seamless care transitions
- Bachelor's degree in nursing, allied health, business, or related field
- Two to four years of clinical experience in post-acute care, home care, acute patient care, discharge planning, case management, and utilization review
- Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes
- One year health insurance plan experience or managed care environment preferred
- Registered Nurse with current unrestricted Michigan Registered Nurse license required
LanceSoft is an equal opportunity employer and a certified Minority Business Enterprise (MBE). We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic.
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