Clinical Review Nurse – Concurrent Review

🔥 2 hours ago

🗽 New York – Remote

🗽 New York – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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, and level of care • Review acuity level, resource consumption, length of stay, and discharge planning • Work with Medical Affairs and/or Medical Directors to discuss member care • Collect, document, and maintain concurrent review findings, discharge plans, and actions in health management systems • Work with healthcare providers to approve medical determinations or provide recommendations based on requested services and review findings • 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 between levels of care and facilities • Collaborate with care management on member referrals • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Bachelor’s degree in Nursing (BSN) or graduation from an accredited school of nursing • 2 to 4 years of related experience • LPN (Licensed Practical Nurse) state licensure required • Active and unrestricted New York State Registered Nurse (RN) license strongly preferred • 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 • Ability to work Monday through Friday, 8:30 AM to 5:00 PM ET, with a one-hour lunch break • Compliance with all policies and standards

🏖️ 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 • Equal opportunity employment • Consideration of qualified applicants with arrest or conviction records in accordance with applicable law