Remote Concurrent Review Nurse – Inpatient Utilization

Centene Corp.; California, Northern (MO, KY); Hybrid; USD 37,000 - 67,000; Full time

Job summary

Centene is seeking a Clinical Review Nurse for concurrent reviews of inpatient admissions under the LA Medicaid line of business. The role supports determining appropriate level of care and discharge planning, working with Medical Affairs and providers. 8am–5pm CST, remote-based, with rotation of on-call duties.

The ideal candidate holds a nursing degree (B.S. or higher) and 2+ years in acute care, with knowledge of Medicare/Medicaid regulations and utilization management processes.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing with 2–4 years of related experience.
• 2+ years of acute care experience required.
• Knowledge of Medicare and Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.

Responsibilities

• Perform concurrent reviews of inpatient admissions to determine appropriate level of care.
• Collaborate with Medical Affairs/Medical Directors on patient care decisions.
• Provide education to providers on utilization processes.
• Document findings and discharge plans in health management systems.

Skills

Clinical knowledge

Utilization management

Discharge planning

Medical necessity

Education

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Tools

Health management systems

Job description

Centene is seeking a Clinical Review Nurse for concurrent reviews of inpatient admissions under the LA Medicaid line of business. The role supports determining appropriate level of care and discharge planning, working with Medical Affairs and providers. 8am–5pm CST, remote-based, with rotation of on-call duties.

The ideal candidate holds a nursing degree (B.S. or higher) and 2+ years in acute care, with knowledge of Medicare/Medicaid regulations and utilization management processes.