Remote Clinical Review Nurse - Medicaid Care Leader

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

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.