Clinical Review Nurse - Concurrent Review

Centene; Illinois; Remote; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,Hybrid

Job summary

Centene is seeking a Clinical Review Nurse for a remote role in Illinois. The position focuses on concurrent reviews to assess care needs, utilization management, and discharge planning, leveraging experience in acute care to ensure high-quality outcomes.

The role involves collaborating with Medical Affairs, documenting findings, and educating providers on utilization processes. It requires nursing licensure in Illinois and 2+ years of acute care experience, with a flexible schedule and remote

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing.
• 2+ years of acute care experience required.
• RN (Registered Nurse) - State Licensure in Illinois required.
• LPN (Licensed Practical Nurse) - State Licensure required.

Responsibilities

• Perform concurrent reviews of members for appropriate care and setting.
• Review quality and continuity of care by assessing acuity level and resource consumption.
• Collaborate with Medical Affairs and/or Medical Directors regarding member care.
• Document and maintain concurrent review findings and discharge plans in health management systems.
• Work with healthcare providers to approve medical determinations based on concurrent review findings.
• Educate providers on utilization processes to ensure high-quality care.
• Provide feedback to leadership on improving care levels and medical necessity.
• Review member transfer or discharge plans for timely transitions.
• Collaborate with care management on member referrals.
• Comply with all policies and standards.

Skills

Acute care experience

Utilization management understanding

Documentation in health systems

Education

Bachelor's degree in Nursing

Tools

Health management systems

Job description

About This Role

The Clinical Review Nurse performs concurrent reviews to assess members' overall health, evaluate the necessity of care, and contribute to discharge planning. This remote position is ideal for nurses with experience in acute care and a strong understanding of utilization management.

Highlights

• Pay: $27.02 - $48.55 per hour
• Location: Remote, IL
• Schedule: Full-time, Monday - Friday, 8am - 5pm CT, rotating weekends and holidays

What You'll Do

• Perform concurrent reviews of members for appropriate care and setting
• Review quality and continuity of care by assessing acuity level and resource consumption
• Collaborate with Medical Affairs and/or Medical Directors regarding member care
• Document and maintain concurrent review findings and discharge plans in health management systems
• Work with healthcare providers to approve medical determinations based on concurrent review findings
• Educate providers on utilization processes to ensure high-quality care
• Provide feedback to leadership on improving care levels and medical necessity
• Review member transfer or discharge plans for timely transitions
• Collaborate with care management on member referrals
• Comply with all policies and standards

Requirements

Education:

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing

Experience:

• 2+ years of acute care experience required
• 2-4 years of related experience preferred

Licenses & Certifications:

• RN (Registered Nurse) - State Licensure in Illinois required
• LPN (Licensed Practical Nurse) - State Licensure required

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules (remote, hybrid, field, or office)

About Centene

Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, making a real impact every day through meaningful challenges and a dedicated team.