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.