Clinical Review Nurse – Concurrent Review

🔥 16 hours ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

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 to determine members’ overall health, appropriate care, medical necessity, and level of care • Review acuity level, resource consumption, length of stay, and discharge planning • Work with Medical Affairs and/or Medical Directors regarding member care • Document concurrent review findings, discharge plans, and actions in medical records and health management systems • Work with healthcare providers on medical determinations and recommendations • Educate providers on utilization processes • Provide leadership feedback on appropriate level of care and medical necessity improvements • Review transfer and discharge plans to support timely transitions between care levels and facilities • Collaborate with care management on member referrals • Comply with policies and standards and perform other assigned duties

🎯 Requirements

• Active, unrestricted Compact RN License required • 2+ years of acute care nursing experience required • Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing • 2–4 years of related experience • 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 • Previous UM, UR, Case Management, or Care Management experience preferred • Preference given to candidates who reside in Missouri

🏖️ Benefits

• Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation