Remote RN: Acute Care Concurrent Review Specialist

Centene Corporation; Illinois; Hybrid; USD 37.000 - 67.000; Vollzeit

Benefits dieser Stelle

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Zusammenfassung

Centene Corporation is seeking an experienced RN for utilization management in Illinois. The role focuses on concurrent reviews to determine appropriate level of care, validates medical necessity, and supports discharge planning.

Remote work from home is offered with standard M-F hours, some weekends/holidays rotation. The ideal candidate will have an Illinois RN license, a nursing degree, 2–4 years of related experience, and knowledge of Medicare/Medicaid regulations.

Qualifikationen

• Requires RN licensure in Illinois.
• 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.

Aufgaben

• Performs concurrent reviews to determine appropriate level of care and setting.
• Review acuity, resource use, length of stay, and discharge planning.
• Collaborate with Medical Affairs/Medical Directors as needed.
• Document findings and discharge plans in health management systems.
• Coordinate with providers to approve determinations or provide recommendations.
• Educate providers on utilization processes to ensure high quality care.
• Provide feedback on improvements to involvement/throughput.
• Review transfer/discharge plans for timely progression between levels of care.

Kenntnisse

Utilization management

Clinical assessment

Acute care experience

Interdisciplinary collaboration

Ausbildung

RN license in Illinois

Bachelor’s degree in Nursing

Accredited nursing program graduate

Tools

Electronic Health Records (EHR)

Health management systems

Jobbeschreibung

Centene Corporation is seeking an experienced RN for utilization management in Illinois. The role focuses on concurrent reviews to determine appropriate level of care, validates medical necessity, and supports discharge planning.

Remote work from home is offered with standard M-F hours, some weekends/holidays rotation. The ideal candidate will have an Illinois RN license, a nursing degree, 2–4 years of related experience, and knowledge of Medicare/Medicaid regulations.