Clinical Review Nurse - Concurrent Review

Centene

Competitive pyy; not specified; comprehensive bene...
Hybrid
Concurrent review of member care
Evaluation of medical necessity
Acute care experience required
This remote role involves performing concurrent reviews to determine the overall health and appropriate level of care for members

Job Summary

  • This remote role involves performing concurrent reviews to determine the overall health and appropriate level of care for members.
  • The position requires working with Medical Affairs and healthcare providers to validate the necessity of inpatient services and approve medical determinations.
  • Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K, and flexible work schedules.

Matching Summary

This remote role involves performing concurrent reviews to determine the overall health and appropriate level of care for members.

Salary

Competitive pay; Not specified; Comprehensive benefits including 401K and stock purchase plans

Skills & Requirements

Must-have

  • Concurrent review of member care
  • Evaluation of medical necessity
  • Acute care experience required
  • Collaboration with healthcare providers
  • Utilization management processes

Nice-to-have

  • Knowledge of Medicare regulations
  • Knowledge of Medicaid regulations
  • Experience in discharge planning
  • Education on utilization processes
  • Feedback on care improvement opportunities

Key Requirements

  • Graduate from Accredited School of Nursing or Bachelor's degree in Nursing
  • 2-4 years of related experience
  • 2+ years of acute care experience
  • LPN State Licensure required
  • RN State Licensure preferred

Work Rights

Not specified

Tailored Resume

Cover Letter