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Remote Clinical Review Nurse – Concurrent Review, WY - Remote Eligible
Improve appropriate level of care and medical necessity based on clinical policies and guidelines.
Remote
Mid-Level
$25.97-$46.68 per hour
4 months ago
Centene
Transforming the health of the communities we serve, one person at a time
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✨ About The Role
- Perform concurrent reviews to determine member's overall health, review care being delivered, evaluate medical necessity, and contribute to discharge planning
- Collaborate with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered
- Collect, document, and maintain concurrent review findings, discharge plans, and actions taken on member medical records
- Work with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings
- Review member's transfer or discharge plans to ensure timely discharge between levels of care and facilities
⚡ Requirements
- Ideal candidate will have a Compact RN License and reside in Pacific Time (PT) or Mountain Time (MT) zones
- Requires 2 – 4 years of related experience with 2+ years of acute care experience
- 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
- Ability to review quality and continuity of care, resource consumption, length of stay, and discharge planning of members
Remote Clinical Review Nurse – Concurrent Review, WY - Remote Eligible
Remote
$25.97-$46.68 per hour
Remote
About Centene
Transforming the health of the communities we serve, one person at a time