Remote RN: Clinical Review & Discharge Planning

Centene Corporation; New York (NY); Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene Corporation seeks a Remote Nurse Reviewer to perform concurrent reviews and determine the appropriate level of care for members. The role requires an active NY RN license with strong preference for NYS licensure and involves Monday–Friday, 8:30 AM–5:00 PM ET availability.

The nurse will document findings, collaborate with Medical Affairs/Medical Directors, and educate providers on utilization processes, aiming to ensure high-quality, appropriate care while complying with policies.

Qualifications

• Bachelor's degree in Nursing (BSN) or graduation from an accredited school of nursing, plus 2 to 4 years of related experience.
• Active NYS RN licensure strongly preferred.

Responsibilities

• Performs concurrent reviews to determine appropriate care and setting.
• Reviews acuity level, resource use, length of stay, and discharge planning.
• Collaborates with Medical Affairs/Medical Directors as needed.
• Documents findings and discharge plans in health management systems.
• Assists providers with utilization decisions and education on processes.
• Provides feedback to leadership on opportunities to improve care and necessity.

Skills

Nursing assessment

Clinical decision making

Communication

Collaboration with physicians

Education

BSN or nursing degree

Tools

Health management systems

Job description

Centene Corporation seeks a Remote Nurse Reviewer to perform concurrent reviews and determine the appropriate level of care for members. The role requires an active NY RN license with strong preference for NYS licensure and involves Monday–Friday, 8:30 AM–5:00 PM ET availability.

The nurse will document findings, collaborate with Medical Affairs/Medical Directors, and educate providers on utilization processes, aiming to ensure high-quality, appropriate care while complying with policies.