What are the responsibilities and job description for the Concurrent Review Nurse RN - Remote position at Superior HealthPlan?
You could be the one who changes everything for our 26 million members as a Concurrent Review Nurse -RN on the Clinical team. Centene is transforming the health of our communities, one person at a time. As a diversified, national Fortune 24 and rapidly growing organization, exceptional talent fuels our mission.
As a Concurrent Review Nurse - RN, you will:
Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.
- Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
- Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
- Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care
- Conduct discharge planning
- Educate providers on utilization and medical management processes
- Provide clinical knowledge and act as a clinical resource to non-clinical team staff
- Enter and maintain pertinent clinical information in various medical management systems
Benefits & Perks:
- Flexible work solutions including remote options, hybrid work schedules and dress flexibility
- Competitive pay
- Paid Time Off including paid holidays
- Health insurance coverage for you and dependents
- 401(k) and stock purchase plans
- Tuition reimbursement and best-in-class training and development
- In-person and virtual training following State and Community guidelines
Education/Experience:
Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2 years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred.Licenses/Certifications: Current state’s RN license is required.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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