Clinical Review Nurse - Concurrent Review

Centene; Pennsylvania; Remote; USD 37,000 - 68,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform concurrent reviews, assess care necessity, and contribute to discharge planning, leveraging case management or utilization management experience.

The position offers day-shift, full-time work with competitive pay and benefits, and the chance to impact patient care across the network. RN licensure and acute care experience are required.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing.
• 2+ years of acute care experience required.
• 2-4 years of related experience preferred.
• RN - Registered Nurse license 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.
• Work with Medical Affairs and/or Medical Directors to discuss member care.
• Collect, document, and maintain concurrent review findings and discharge plans.
• Collaborate with healthcare providers to approve medical determinations.
• Educate providers on utilization processes for 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.

Skills

Case management

Utilization management

Nurse collaboration

Education

Graduate from Accredited School of Nursing

Bachelor's degree in Nursing

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 those with experience in case management or utilization management.

Highlights

• Pay: $27.02 - $48.55 per hour
• Location: Remote, PA
• Schedule: Full-time, Day shift

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
• Work with Medical Affairs and/or Medical Directors to discuss member care
• Collect, document, and maintain concurrent review findings and discharge plans
• Collaborate with healthcare providers to approve medical determinations
• Educate providers on utilization processes for 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
• Perform other duties as assigned

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 and/or Compact State Licensure required

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules

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.