Clinical Review Nurse - Concurrent Review

Centene
Missouri
Workplace: RemoteFull timeUSD 27.02 - 48.55 hourlyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 2-4 yearsSkills: ["Documenting","Clinical judgment","Care coordination"]

Perform concurrent reviews for members in a Medicaid-focused role, determining overall health, evaluating medical necessity, and supporting appropriate level-of-care and discharge planning. Review inpatient services for necessity, acuity, resource consumption, and length of stay, documenting findings in health management systems. Partner with Medical Affairs/Medical Directors and providers, and provide utilization education and feedback to leadership to improve care quality.

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FursaFursa
Centene
Centene
1 day ago

Clinical Review Nurse - Concurrent Review

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live
Reposted: similar role first listed 6 months ago

Job Summary

Perform concurrent reviews for members in a Medicaid-focused role, determining overall health, evaluating medical necessity, and supporting appropriate level-of-care and discharge planning. Review inpatient services for necessity, acuity, resource consumption, and length of stay, documenting findings in health management systems. Partner with Medical Affairs/Medical Directors and providers, and provide utilization education and feedback to leadership to improve care quality.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Perform concurrent reviews, including assessing overall health and evaluating medical necessity according to policies and guidelines
  • •Determine appropriate care and setting, including reviewing acuity level, resource consumption, and length of stay
  • •Collect, document, and maintain concurrent review findings and discharge plans in health management systems
  • •Collaborate with providers to approve medical determinations or provide recommendations based on concurrent review findings
  • •Support discharge planning and coordinate referrals with care management and other internal stakeholders as appropriate

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly
Perks:Health Insurance401kEquityLearning BudgetPaid LeaveRemote Work

Key Requirements

  • •RN - Registered Nurse license for Missouri Medicaid (State Licensure and/or Compact State Licensure for MO Medicaid)
  • •Graduate from an accredited School of Nursing or Bachelor’s degree in Nursing
  • •2–4 years of related experience, including 2+ years of acute care experience
  • •Clinical knowledge to determine overall health, treatment needs, and appropriate level of care
  • •Knowledge of utilization management processes and Medicare/Medicaid regulations preferred
Experience:2-4 yearsMedicaidUtilization managementAcute care
Education:
Skills:DocumentingClinical judgmentCare coordination
Licenses:Missouri RN license (MO Medicaid)
Certifications:RN - Registered Nurse
Tech Stack:Health management systems

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn