Clinical Review Nurse - Concurrent Review

About This Role

The Clinical Review Nurse performs concurrent reviews to determine members' overall health, evaluate medical necessity, and contribute to discharge planning. This role is ideal for nurses with experience in acute care and a strong understanding of utilization management processes.

• Pay: $27.02 - $48.55 per hour
• Location: Remote, NY
• Schedule: Full-time, Monday-Friday, 8:30 AM to 5:00 PM ET/EST

• Perform concurrent reviews of members for appropriate care and setting.
• Review quality and continuity of care by assessing acuity level and resource consumption.
• Work with Medical Affairs and/or Medical Directors to discuss member care.
• Collect, document, and maintain concurrent review findings in health management systems.
• Collaborate with healthcare providers to approve medical determinations.
• Educate providers on utilization processes to ensure high-quality care.
• Provide feedback to leadership on improving care levels and medical necessity.
• Review member transfer or discharge plans for timely discharges.
• Collaborate with care management on member referrals.
• Perform other duties as assigned and comply with all policies and standards.

Education:

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing

Experience:

• 2+ years of acute care experience required
• 2-4 years of related experience preferred

Licenses &

Certifications:

• Active and unrestricted New York State Registered Nurse (RN) licensure strongly preferred

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules

Centene is a diversified, national organization committed to delivering exceptional healthcare services. They offer competitive benefits and a fresh perspective on workplace flexibility, valuing diversity and inclusion in their workforce.