Clinical Review Nurse – Concurrent Review

🔥 0 minutes ago

🗽 New York – Remote

🗽 New York – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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, evaluate care delivered, assess medical necessity, and contribute to discharge planning • Evaluate inpatient services to validate the necessity and setting of care • Determine appropriate care levels and settings based on member health • Review quality and continuity of care, including acuity, resource consumption, length of stay, and discharge planning • Discuss member care with Medical Affairs and/or Medical Directors as needed • Collect, document, and maintain review findings, discharge plans, and actions in medical records and health management systems • Work with healthcare providers to approve medical determinations or provide recommendations • Educate providers on utilization processes • Provide leadership feedback on care-level and medical-necessity improvement opportunities • Review transfer and discharge plans to support timely transitions • Collaborate with care management on member referrals • Comply with policies and standards and perform other assigned duties

🎯 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 • Active and unrestricted New York State Registered Nurse (RN) licensure strongly preferred for consideration • LPN state licensure required • Clinical knowledge to determine member health, treatment needs, and appropriate care level preferred • Knowledge of Medicare and Medicaid regulations preferred • Knowledge of utilization management processes preferred • Ability to work Monday–Friday, 8:30 AM–5:00 PM Eastern Time with a one-hour lunch break • Ability to work fully remotely

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off • Paid holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Incentives may be included in total compensation