Remote NICU Clinical Review Nurse

IntelliResume; Oklahoma; Remote; USD 70,000 - 100,000; 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 seeks a Clinical Review Nurse-Concurrent Review to perform concurrent reviews, assessing acuity, resource use, and care setting, with a focus on neonatal-related care. Ideal for nurses with neonatal experience and understanding of utilization management processes.

This remote, US-based role offers a full-time schedule, Monday–Friday 8am–5pm with rotational weekends and holidays, and opportunities to collaborate with Medical Affairs and providers while ensuring high-quality, appropriate

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing.
• 2+ years of acute care experience required.
• 3 years of neonatal level II or IV NICU experience preferred.

Responsibilities

• Perform concurrent reviews of members for appropriate care and setting.
• Review quality and continuity of care by assessing acuity level, resource consumption, and length of stay.
• Collaborate with Medical Affairs and/or Medical Directors regarding member care.
• Document and maintain concurrent review findings and discharge plans in health management systems.
• Work with healthcare providers to approve medical determinations 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 transfer or discharge plans for timely transitions.
• Collaborate with care management on member referrals.

Skills

Acute care experience

Neonatal NICU experience

Education

RN or BSN

Job description

Centene seeks a Clinical Review Nurse-Concurrent Review to perform concurrent reviews, assessing acuity, resource use, and care setting, with a focus on neonatal-related care. Ideal for nurses with neonatal experience and understanding of utilization management processes.

This remote, US-based role offers a full-time schedule, Monday–Friday 8am–5pm with rotational weekends and holidays, and opportunities to collaborate with Medical Affairs and providers while ensuring high-quality, appropriate