Centene Corporation
10,000+ employees
Founded 1984
🛡️ Insurance
💼 Consulting
🏥 Healthcare
Insurance • Consulting • Healthcare
Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.
Clinical Review Nurse – Concurrent Review
🕒 October 9
Where this job comes from
Posted on Centene Corporation's careers page, not through a job board
First seen by Remote Rocketship October 9
Still open on Centene Corporation's site. Checked 2 hours ago.
Centene Corporation
10,000+ employees
Founded 1984
🛡️ Insurance
💼 Consulting
🏥 Healthcare
Insurance • Consulting • Healthcare
Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.
📋 Description
• Perform concurrent reviews, including determining members’ overall health, reviewing care delivered, evaluating medical necessity, and contributing to discharge planning • Evaluate inpatient services to validate necessity and care setting • Determine appropriate care and level of care based on member health • Review acuity level, resource consumption, length of stay, and discharge planning • Work with Medical Affairs and/or Medical Directors regarding member care • Collect, document, and maintain review findings, discharge plans, and actions in health management systems • Work with healthcare providers to approve medical determinations or provide recommendations • Educate providers on utilization processes • Provide leadership feedback on opportunities to improve level of care and medical necessity • Review transfer and discharge plans to support timely transitions • Collaborate with care management on member referrals • Comply with all policies and standards • Perform other duties as assigned
🎯 Requirements
• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing • 2–4 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 • RN - Registered Nurse - State Licensure and/or Compact State Licensure • MO RN Licensure highly preferred • Post acute care experience and/or utilization review experience highly preferred
🏖️ Benefits
• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Equal opportunity employment • Consideration for qualified applicants with arrest or conviction records in accordance with the LA County Ordinance and the California Fair Chance Act
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