Clinical Review Nurse — Utilization & Discharge Expert

Centene Management Company LLC; New Jersey; Hybrid; 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 + holidays

Remote/hybrid/field or office work

Job summary

Centene Management Company LLC is seeking an LPN to perform concurrent reviews, assess the member's overall health, and determine appropriate care setting and level of care. You will review inpatient services for medical necessity and contribute to discharge planning.

You will collaborate with Medical Affairs/Medical Directors, educate providers on utilization processes, document findings, and ensure timely transfers or discharges while adhering to policies.

Qualifications

• Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2–4 years of related experience.
• 2+ years of acute care experience required.
• LPN - Licensed Practical Nurse license required.
• Knowledge of Medicare and Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.

Responsibilities

• Performs concurrent reviews to determine overall health and appropriate level of care.
• Reviews acuity level, resource consumption, length of stay, and discharge planning.
• Collaborates with Medical Affairs/Medical Directors to discuss member care.
• Maintains concurrent review findings, discharge plans, and actions in health management systems.
• Assists providers with approvals or recommendations based on concurrent review findings.
• Provides education to providers on utilization processes to ensure high-quality care.
• Offers feedback to leadership on opportunities to improve appropriate level of care and medical necessity.
• Reviews transfer/discharge plans for timely discharge between levels of care and facilities.

Skills

Clinical assessment

Care coordination

Utilization review

Discharge planning

Inpatient care knowledge

Education

Graduate from an Accredited School of Nursing or BSN

Job description

Centene Management Company LLC is seeking an LPN to perform concurrent reviews, assess the member's overall health, and determine appropriate care setting and level of care. You will review inpatient services for medical necessity and contribute to discharge planning.

You will collaborate with Medical Affairs/Medical Directors, educate providers on utilization processes, document findings, and ensure timely transfers or discharges while adhering to policies.