Remote RN Clinical Review Nurse: Utilization & Discharge

Centene Corp.; New York (NY); Hybride; USD 37 000 - 67 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Résumé du poste

Centene Corp. is seeking a fully remote nurse reviewer to evaluate concurrent care plans and determine appropriate levels of care for members. The role prefers an active NY State RN license and requires availability Monday–Friday, 8:30 AM–5:00 PM ET with a one-hour lunch.

Responsibilities include reviewing acuity and discharge planning, collaborating with Medical Affairs, documenting findings, and educating providers on utilization processes. Pay ranges are stated and benefits are offered.

Qualifications

• BSN in Nursing or equivalent from an accredited program.
• Active RN license required; NYS RN lic preferred.
• Knowledge of Medicare/Medicaid and utilization management is a plus.

Responsabilités

• Perform concurrent reviews to assess care level and health status.
• Review acuity, resource use, length of stay, and discharge planning.
• Collaborate with Medical Affairs/Medical Directors on patient care.
• Document concurrent review findings and discharge plans in health systems.
• Educate providers on utilization processes and policies.
• Provide feedback to leadership on care appropriateness and needs.

Connaissances

RN license

New York RN license

Formation

BSN in Nursing

2-4 years related experience

Description du poste

Centene Corp. is seeking a fully remote nurse reviewer to evaluate concurrent care plans and determine appropriate levels of care for members. The role prefers an active NY State RN license and requires availability Monday–Friday, 8:30 AM–5:00 PM ET with a one-hour lunch.

Responsibilities include reviewing acuity and discharge planning, collaborating with Medical Affairs, documenting findings, and educating providers on utilization processes. Pay ranges are stated and benefits are offered.