Join Centene as a Clinical Review Nurse in a fully remote setting, focused on evaluating patient care and medical necessity. Enjoy a structured schedule while making a meaningful impact.
In this critical role, you will conduct concurrent reviews of members’ health, assess the appropriateness of care, and contribute to discharge planning. Your expertise will be fundamental in ensuring high-quality care, as well as validating the necessity of inpatient services. This position requires an active RN license in California and a blend of clinical evaluation and communication skills.
Key Responsibilities:
• Perform concurrent reviews of member care and health
• Evaluate medical necessity and setting of delivered services
• Collaborate with Medical Affairs and providers on care plans
• Document review findings in health management systems
• Provide education on utilization processes to healthcare providers
Requirements:
• Active RN license in California
• 2+ years of acute care nursing experience
• Graduate from an accredited nursing school
• Knowledge of Medicare/Medicaid regulations preferred
• Familiarity with utilization management processes preferred
Utilize your clinical acumen to enhance patient outcomes and healthcare quality in this vital role at Centene.
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