Clinical Review Nurse - Concurrent Review

Centene Corporation • Burr Ridge, IL • 2h ago

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.

NOTE: This is a fully remote role. Preference will be given to applicants (1) with an active Illinois or a compact LPN or RN licensure, (2) as well as some experience in each of the following areas: acute care, utilization management (UM), InterQual knowledge, and discharge planning knowledge.

Additional Details:

Department: Concurrent Review MCD
Business Unit: Corporate
Schedule: Mon-Fri 8am - 5pm CST with rotating weekends and holidays (required). Subject to change per business.

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.

Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care

Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member

Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered

Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines

Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings

Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members

Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines

Reviews member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities

Collaborates with care management on referral of members as appropriate

Performs other duties as assigned

Complies with all policies and standards

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:

LPN - Licensed Practical Nurse - State Licensure required

For Health Net of California: RN license required

Pay Range: $26.50 - $47.59 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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

Similar Jobs

District Manager I- Aramark Collegiate Hospitality

ARAMARK • Chicago, IL • 1h ago

Hospital & Medical

Job Description The District Manager is responsible for providing the overall vision, planning, direction, and control to assigned units for a geographic district normally generating $12-30M+ in revenue. This key leaders...

1h ago

Go to Apply

Licensed Practical Nurse

CVS Health • Naperville, IL • 2h ago

Hospital & Medical

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions compan...

2h ago

Go to Apply

Nurse Practitioner

CVS Health • Chicago, IL • 2h ago

Hospital & Medical

2h ago

Go to Apply

PRN Occupational Therapist

Enhance Rehabilitation • Aurora, IL • 3h ago

Hospital & Medical

Enhance Rehabilitation is currently seeking qualified Occupational Therapist candidates to join our dynamic team. As an Enhance Rehabilitation Occupational Therapist, you will be a part of growing team. In this role, you...

3h ago

Go to Apply

Pharmacy Manager

Walgreens • Chicago, IL • 3h ago

Hospital & Medical

Job Description: Job Summary: Provides empathetic pharmacy consulting services to patients regarding the effective use of medications and drug interaction awareness. Offers preventive and clinical healthcare services, in...

3h ago

Go to Apply

Physical Therapist Assistant

Enhance Rehabilitation • Glenwood, IL • 19h ago

Hospital & Medical

Enhance Rehabilitation is currently seeking qualified physical therapy assistant candidates to join our dynamic team. As an Enhance Rehabilitation physical therapist assistant, working under the guidance of a physical th...

19h ago

Go to Apply

PRN Physical Therapist Assistant

Enhance Rehabilitation • Glenwood, IL • 19h ago

Hospital & Medical

19h ago

Go to Apply

Center Manager- Physical Therapist/Occupational Therapist $10,000 Sign on Bonus

Select Medical • Chicago, IL • 19h ago

Hospital & Medical

Overview Position: Center Manager- Physical Therapist/ Occupational Therapist Location: 1725 W Harrison St, Suite 440, Chicago, IL-60612 Schedule: Full Time Compensation: $84,000-115,000annually, based on years of experi...

19h ago

Go to Apply

Diagnostic Radiologic Technologist (MRI)

Veterans Affairs, Veterans Health Administration • Chicago, IL • 1d ago

Hospital & Medical

Summary This position is located in the Diagnostic Imaging Service within the Jesse Brown VA Medical Center in Chicago, IL. The Diagnostic Radiologic Technologist operates the Magnetic Resonance Imaging (MR) machine. asp...

1d ago

Go to Apply

Diagnostic Radiologic Technologist (CT)

Veterans Affairs, Veterans Health Administration • Chicago, IL • 1d ago

Hospital & Medical

Summary This position is located in the Diagnostic Imaging Service within the Jesse Brown VA Medical Center in Chicago, IL. The Diagnostic Radiologic Technologist (Computed Tomography) performs computerized tomography of...

1d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.