Clinical Review Nurse - Concurrent Review

Remote concurrent review nurse role supporting Centene's Medical Management/Health Services team. Performs concurrent reviews of inpatient services to evaluate medical necessity, level of care, and contribute to discharge planning per care policies and guidelines. Reviews acuity, resource consumption, length of stay, and discharge plans to ensure quality and continuity of care. Collaborates with Medical Directors and Medical Affairs on member care decisions, and works with providers to approve medical determinations or make recommendations based on review findings. Documents review findings, discharge plans, and actions in health management systems per UM policies. Provides provider education on utilization processes, gives feedback to leadership on opportunities to improve appropriate level of care, and collaborates with care management on member referrals. Schedule: Monday–Friday, 8am–5pm CST, with a rotating weekend/holiday schedule. Requires graduation from an accredited school of nursing or BSN, plus 2–4 years of related experience including 2+ years of acute care. Post-acute experience strongly preferred. Knowledge of Medicare/Medicaid regulations and utilization management processes preferred. Must hold an active Louisiana or compact RN license; role is open to remote workers anywhere in the US. Pay range: $27.02–$48.55/hour.