Clinical Review Nurse – Concurrent Review (Remote Opportunity)

Join our team of clinical professionals at Centene, a national organization dedicated to delivering high-quality healthcare services to our 28 million members. As a Clinical Review Nurse, you will play a vital role in our Medical Management/Health Services team, utilizing your clinical expertise to make a positive impact on our members' lives. Enjoy a competitive benefits package, including a fresh perspective on workplace flexibility, and take advantage of our remote work opportunity.

Job Summary

We are seeking a skilled Clinical Review Nurse to perform concurrent reviews, determining the overall health of our members, reviewing the type of care being delivered, and evaluating medical necessity. You will contribute to discharge planning, assist in evaluating inpatient services, and collaborate with healthcare providers to ensure high-quality, appropriate care. If you are a motivated and detail-oriented clinical professional looking for a challenging and rewarding role, we encourage you to apply.

Key Responsibilities

• Perform concurrent reviews to determine members' overall health and appropriate level of care
• Review quality and continuity of care, including acuity level, resource consumption, length of stay, and discharge planning
• Collaborate with Medical Affairs and/or Medical Directors to discuss member care and provide recommendations
• Collect, document, and maintain concurrent review findings, discharge plans, and actions taken on member medical records
• Work with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings
• Provide education to providers on utilization processes to ensure high-quality, appropriate care
• Offer feedback to leadership on opportunities to improve care and medically necessity based on clinical policies and guidelines
• Review member transfer or discharge plans to ensure timely discharge between levels of care and facilities
• Collaborate with care management on referral of members as appropriate

Requirements

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2-4 years of related experience, with 2+ years of acute care experience required
• Clinical knowledge and ability to determine overall health of members, including treatment needs and appropriate level of care
• Knowledge of Medicare and Medicaid regulations, utilization management processes, and clinical policies and guidelines preferred
• LPN - Licensed Practical Nurse - State Licensure required; RN preferred

What We Offer

• Competitive pay ($26.50 - $47.59 per hour)
• Comprehensive benefits package, including health insurance, 401K, and stock purchase plans
• Tuition reimbursement, paid time off, and holidays
• Flexible approach to work, with remote, hybrid, field, or office work schedules

Centene is an equal opportunity employer committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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