Clinical Review Nurse - Concurrent Review (rn)

Centene

Remote
Hybrid
Concurrent reviews
Evaluate medical necessity
Discharge planning
Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines

Job Summary

  • Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines.
  • Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered and collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records.
  • Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

Matching Summary

Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines.

Skills & Requirements

Must-have

  • Concurrent reviews
  • Evaluate medical necessity
  • Discharge planning
  • Review inpatient services
  • Health management systems documentation

Nice-to-have

  • Fresh perspective on workplace flexibility
  • Contribute to care improvement
  • Collaborate with care management
  • Provide education to providers

Key Requirements

  • Graduate from Accredited School of Nursing or BSN
  • 2-4 years related experience
  • 2+ years acute care experience
  • LPN State Licensure required
  • RN license required (CA)
  • RN State/Compact Licensure required (NV)
  • Licensed in Nevada

Work Rights

Not specified

Tailored Resume

Cover Letter