Clinical Review Nurse - Concurrent Review

The Clinical Review Nurse
- Concurrent Review performs concurrent reviews to assess members' overall health, evaluate medical necessity, and contribute to discharge planning. This role is ideal for experienced nurses looking to support Medicaid and Market Place/Ambetter members in a remote setting.

• Pay: $27.02 - $48.55 per hour
• Location: Remote, WA
• Residency: Must reside in Central, Mountain, or Pacific Time Zone
• Schedule: Full-time, Monday-Friday 8am - 5pm, with rotational Saturdays and holidays

• Perform concurrent reviews of members for appropriate care and setting
• Review quality and continuity of care by assessing acuity level and resource consumption
• Collaborate with Medical Affairs and/or Medical Directors regarding member care
• Document and maintain concurrent review findings and discharge plans in health management systems
• Approve medical determinations or provide recommendations based on concurrent review findings
  
  Educate providers on utilization processes to ensure high-quality care
• Provide feedback to leadership on improving care levels and medical necessity
• Review member’s transfer or discharge plans for timely transitions
• Collaborate with care management on member referrals
• Perform other duties as assigned and comply with all policies and standards

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

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

• LPN
  - Licensed Practical Nurse
  - State Licensure required
• RN
  - Registered Nurse
  - State Licensure and/or Compact State Licensure for State of Nevada required

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules (remote, hybrid, field, or office)

Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, making a real impact every day through meaningful challenges and a dedicated team.