Clinical Review Nurse
7 days ago
Join to apply for the Clinical Review Nurse - Concurrent Review role at Centene Corporation.
OverviewYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits and a fresh perspective on workplace flexibility.
Responsibilities- Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care.
- Reviews quality and continuity of care by evaluating acuity level, resource consumption, length of stay, and discharge planning.
- Works with Medical Affairs and/or Medical Directors to discuss member care being delivered.
- Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines.
- Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings.
- Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members.
- Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessary interventions based on clinical policies and guidelines.
- Reviews members transfer or discharge plans to ensure timely discharge between levels of care and facilities.
- Collaborates with care management on referral of members as appropriate.
- Performs other duties as assigned.
- Complies with all policies and standards.
Schedule: MondayFriday, 8 a.m.5 p.m. Mandatory work at least one weekend day each week; preference for both weekend days. Participation in a rotational holiday schedule is required. Active compact RN license required.
Education & Experience- Graduate from an Accredited School of Nursing or Bachelors degree in Nursing with 24 years of related experience. 2+ years of acute care experience required.
- Clinical knowledge and ability to determine overall health of member, including treatment needs and appropriate level of care preferred.
- Knowledge of Medicare and Medicaid regulations preferred.
- Knowledge of utilization management processes preferred.
- LPN - Licensed Practical Nurse, State Licensure required.
Compensation and Benefits
Pay Range: $26.50 $47.59 per hour. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office schedules. Actual pay will be adjusted based on an individuals skills, experience, education, and other job-related factors permitted by law.
EEO StatementCentene is an equal opportunity employer committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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