Clinical Review Nurse - Concurrent Review

Centene
New York
Workplace: RemoteFull timeUSD 27.02 - 48.55 hourlyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 2-4 yearsEducation: bachelorsSkills: ["Documentation","Collaboration","Clinical judgment","Communication"]

Perform concurrent reviews for members on Centene’s Medical Management/Health Services team by evaluating overall health, care type, medical necessity, acuity, resource use, and length of stay. Document findings and discharge plans in utilization management systems, collaborate with providers to approve determinations or recommendations, and partner with Medical Affairs/Medical Directors and care management to support appropriate level of care and timely discharges.

Loading

Loading job details...

Preparing the role view and application actions.

FursaFursa
Centene
Centene
1 day ago

Clinical Review Nurse - Concurrent Review

✓ Verified Job

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

Source: Company careers pageValidated by: Fursa AI
Last checked: 10 hours agoStatus: Live
Reposted: similar role first listed 4 months ago

Job Summary

Perform concurrent reviews for members on Centene’s Medical Management/Health Services team by evaluating overall health, care type, medical necessity, acuity, resource use, and length of stay. Document findings and discharge plans in utilization management systems, collaborate with providers to approve determinations or recommendations, and partner with Medical Affairs/Medical Directors and care management to support appropriate level of care and timely discharges.
Location: New York
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Perform concurrent reviews to determine overall health and appropriate care and level of care.
  • •Review quality and continuity of care by assessing acuity, resource consumption, length of stay, and discharge planning.
  • •Collect, document, and maintain concurrent review findings and discharge plans in health management systems.
  • •Coordinate with Medical Affairs/Medical Directors and healthcare providers to discuss member care and support medical determinations.
  • •Collaborate with care management on referrals and review transfer/discharge plans to support timely discharge between levels of care and facilities.

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly
Perks:Health Insurance401kEquityLearning BudgetPaid Leave

Key Requirements

  • •Graduate from an accredited School of Nursing or Bachelor’s degree in Nursing.
  • •2–4 years of related experience and 2+ years of acute care experience.
  • •Active and unrestricted New York State Registered Nurse (RN) licensure (strongly preferred).
  • •Ability to work Monday–Friday 8:30 AM to 5:00 PM Eastern Time (ET/EST) hours.
  • •Preferred clinical knowledge to determine overall health, treatment needs, and appropriate level of care.
Experience:2-4 yearsHealthcareUtilization managementAcute care
Education:Bachelor's in Nursing
Skills:DocumentationCollaborationClinical judgmentCommunication
Licenses:NYS RN LicensureLPN - State Licensure
Tech Stack:Utilization 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