Concurrent Review Nurse I
Company: Home State Health Plan
Location: Saint Joseph
Posted on: June 18, 2022
***Position is REMOTE MO***
You could be the one who changes everything for our 26 million
members. Centene is transforming the health of our communities, one
person at a time. As a diversified, national organization, you'll
have access to competitive benefits including a fresh perspective
on workplace flexibility.
Perform onsite review of emergent/urgent and continued stay
requests for appropriate care and setting, following guidelines and
policies, and approve services or forward requests to the
appropriate Physician or Medical Director with recommendations for
Complete medical necessity and level of care reviews for requested
services using clinical judgment and refer to Medical Directors for
review depending on case findings
Collaborate with various staff within provider networks and
discharge planning team electronically, telephonically, or onsite
to coordinate member care
Conduct discharge planning
Educate providers on utilization and medical management
Provide clinical knowledge and act as a clinical resource to
non-clinical team staff
Enter and maintain pertinent clinical information in various
medical management systems
Our Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work
schedules and dress flexibility
Paid Time Off including paid holidays
Health insurance coverage for you and dependents
401(k) and stock purchase plans
Tuition reimbursement and best-in-class training and
Promote the quality and cost effectiveness of medical care by
applying clinical acumen and the appropriate application of
policies and guidelines to emergent/urgent and continued stay
Education/Experience:Graduate from an Accredited School of Nursing.
Bachelor's degree in Nursing preferred. 2+ years of clinical
nursing experience. Acute care experience preferred Knowledge of
healthcare and managed care preferred.
Licenses/Certifications: Current state's LPN/LVN or RN license.
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.
Keywords: Home State Health Plan, Saint Joseph , Concurrent Review Nurse I, Healthcare , Saint Joseph, Missouri
Didn't find what you're looking for? Search again!