Clinical Review Nurse-Concurrent Review

About This Role The Clinical Review Nurse-Concurrent Review performs concurrent reviews to determine members' overall health and the appropriateness of care delivered. This role is ideal for nurses with experience in neonatal care and a strong understanding of utilization management processes. Highlights Location: Remote, OK Schedule: Full Time, Monday-Friday 8am - 5pm, rotational weekends and holidays Work Style: Fully remote Brand/Division: Centene What You'll Do Perform concurrent reviews of members for appropriate care and setting Review quality and continuity of care by assessing acuity level, resource consumption, and length of stay Collaborate with Medical Affairs and/or Medical Directors regarding member care Document and maintain concurrent review findings and discharge plans in health management systems Work with healthcare providers to approve medical determinations 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 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 Requirements Education: Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing Experience: 2+ years of acute care experience required 3 years of neonatal level II or IV NICU experience preferred Licenses & Certifications: RN (Registered Nurse) - State Licensure and/or Compact State Licensure required LPN (Licensed Practical Nurse) - State Licensure required Benefits Competitive pay Health insurance 401K and stock purchase plans Tuition reimbursement Paid time off plus holidays Flexible work schedules (remote, hybrid, field, or office) About Centene Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, supporting individuals, families, and communities through meaningful challenges and a dedicated team. #J-18808-Ljbffr Centene