Remote Clinical Review Nurse - Utilization & Discharge

Centene Management Company LLC; New York (NY); Hybride; USD 37 000 - 67 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Résumé du poste

Centene Management Company LLC is seeking a remote RN reviewer to perform concurrent reviews, determine appropriate level of care, and support discharge planning for members. Strong preference for an active NY RN license; typical hours are Mon-Fri 8:30 AM–5:00 PM ET, with a one-hour lunch.

Responsibilities include reviewing acuity, resource use, and discharge planning, collaborating with Medical Affairs, and educating providers on utilization processes to ensure high-quality care.

Qualifications

• Bachelor’s degree in Nursing (BSN) or graduation from an accredited school of nursing, plus 2 to 4 years of related experience.
• Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred.
• Knowledge of Medicare and Medicaid regulations preferred.

Responsabilités

• Perform concurrent reviews to determine appropriate care and setting.
• Assess acuity level, resource use, length of stay, and discharge planning.
• Collaborate with Medical Affairs/Medical Directors on member care.
• Document and maintain concurrent review findings and discharge plans.
• Educate providers on utilization processes to ensure quality care.
• Provide feedback to leadership on improvement opportunities for care levels.

Connaissances

RN License

Utilization management

Medicare/Medicaid knowledge

Clinical assessment

Formation

BSN degree

Description du poste

Centene Management Company LLC is seeking a remote RN reviewer to perform concurrent reviews, determine appropriate level of care, and support discharge planning for members. Strong preference for an active NY RN license; typical hours are Mon-Fri 8:30 AM–5:00 PM ET, with a one-hour lunch.

Responsibilities include reviewing acuity, resource use, and discharge planning, collaborating with Medical Affairs, and educating providers on utilization processes to ensure high-quality care.