Remote Clinical Review Nurse - Utilization & Discharge

Centene Corporation; Michigan; À distance; USD 37 000 - 67 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible remote/work arrangements

Résumé du poste

Centene Corporation is seeking a remote Utilization Review Nurse to perform concurrent reviews and validation of appropriate care levels. You will assess inpatient services, discharge planning, and coordination with Medical Affairs across Medicaid and Marketplace programs.

Ideal candidates hold an RN or LPN license with Michigan licensure, have 2+ years acute care experience, and familiarity with utilization management processes. Remote, with time-zone flexibility for Central/Eastern regions.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s in Nursing.
• 2–4 years of related experience; 2+ years acute care required.
• Knowledge of Medicare and Medicaid regulations preferred.

Responsabilités

• Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care.
• Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member.
• Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered.
• Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines.
• Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings.
• Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members.
• Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines.
• Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities.
• Collaborates with care management on referral of members as appropriate.
• Performs other duties as assigned.
• Complies with all policies and standards.

Connaissances

Nursing knowledge

Clinical assessment

Utilization management

Acute care experience

Formation

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Description du poste

Centene Corporation is seeking a remote Utilization Review Nurse to perform concurrent reviews and validation of appropriate care levels. You will assess inpatient services, discharge planning, and coordination with Medical Affairs across Medicaid and Marketplace programs.

Ideal candidates hold an RN or LPN license with Michigan licensure, have 2+ years acute care experience, and familiarity with utilization management processes. Remote, with time-zone flexibility for Central/Eastern regions.