Clinical Review Nurse - Concurrent Review

Centene; Washington; Remote; USD 37.000 - 68.000; Vollzeit

Benefits dieser Stelle

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,Hybrid

Zusammenfassung

Centene is seeking a Clinical Review Nurse - Concurrent Review to perform concurrent reviews, assess medical necessity, and contribute to discharge planning. This role supports Medicaid and Marketplace/Ambetter members in a remote setting.

The position offers full-time hours, with a pay range of $27.02–$48.55 per hour and requires nursing licensure (RN or LPN) with Nevada licensure where applicable, plus 2+ years of acute care experience.

Qualifikationen

• 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
• LPN or RN licensure required (RN licensure may require Nevada licensure)

Aufgaben

• 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
• Approve medical determinations or provide recommendations 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’s transfer or discharge plans for timely transitions
• Collaborate with care management on member referrals
• Perform other duties as assigned and comply with all policies and standards

Ausbildung

Nursing degree or RN/LPN qualification

Jobbeschreibung

About This Role

The Clinical Review Nurse - Concurrent Review performs concurrent reviews to assess members' overall health, evaluate medical necessity, and contribute to discharge planning. This role is ideal for experienced nurses looking to support Medicaid and Market Place/Ambetter members in a remote setting.

Highlights

• Pay: $27.02 - $48.55 per hour
• Location: Remote, WA
• Residency: Must reside in Central, Mountain, or Pacific Time Zone
• Schedule: Full-time, Monday-Friday 8am - 5pm, with rotational Saturdays 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
• Approve medical determinations or provide recommendations based on concurrent review findingsEducate providers on utilization processes to ensure high-quality care
• Provide feedback to leadership on improving care levels and medical necessity
• Review member’s transfer or discharge plans for timely transitions
• Collaborate with care management on member referrals
• Perform other duties as assigned and 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

• LPN - Licensed Practical Nurse - State Licensure required
• RN - Registered Nurse - State Licensure and/or Compact State Licensure for State of Nevada 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.