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RN Clinical Review Nurse - Concurrent Review

extra holidays - extra parental leave

Remote:

Full Remote

Contract:

Full time

Salary:

50 - 90K yearly

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

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, CA RN Licensure required, Knowledge of Medicare, Medicaid and utilization management preferred.

Key responsabilities:

Perform concurrent reviews to assess member's health
Evaluate medical necessity and contribute to discharge planning
Assist in validating inpatient services necessity and care setting

Centene Corporation XLarge https://www.centene.com/

10001 Employees

See more Centene Corporation offers

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Fully Remote position that requires a CA RN Licensure.

Position Purpose:
Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.

Education/Experience:
Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required.

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.
Knowledge of utilization management processes preferred.

License/Certification:

For Health Net of California: RN license required

Pay Range: $25.97 - $46.68 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act