Remote Clinical Review Nurse - Utilization & Discharge

Centene; North Carolina; Remote; USD 37,000 - 68,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene is seeking a Clinical Review Nurse to perform concurrent reviews to assess members' health, determine medical necessity, and contribute to discharge planning according to care policies. This role suits nurses with acute care experience and strong utilization management knowledge.

You will work remotely in North Carolina, with a full-time day shift and pay ranging from $27.02 to $48.55 per hour. Responsibilities include collaboration with Medical Affairs, documenting findings, educating

Qualifications

• Graduate from an Accredited School of Nursing or hold a Bachelor's in Nursing.
• 2+ years of acute care experience required.
• RN or LPN licensure required per state.

Responsibilities

• Perform concurrent reviews to assess appropriate care and setting.
• Collaborate with Medical Affairs and Medical Directors on member care.
• Document concurrent review findings and discharge plans in health management systems.
• Educate providers on utilization processes to ensure quality care.
• Review transfer or discharge plans for timely transitions.

Skills

Acute care experience

Utilization management

Collaboration with Medical Affairs

Documentation skills

Education

Bachelor’s degree in Nursing

Accredited School of Nursing

Tools

Health management systems

Job description

Centene is seeking a Clinical Review Nurse to perform concurrent reviews to assess members' health, determine medical necessity, and contribute to discharge planning according to care policies. This role suits nurses with acute care experience and strong utilization management knowledge.

You will work remotely in North Carolina, with a full-time day shift and pay ranging from $27.02 to $48.55 per hour. Responsibilities include collaboration with Medical Affairs, documenting findings, educating