Clinical Review Nurse - Concurrent Review

Centene is a national healthcare organization providing managed care services and health solutions to millions of members across the United States. The Clinical Review Nurse - Concurrent Review evaluates inpatient care, determines medical necessity, collaborates with healthcare providers, and ensures appropriate levels of care through utilization management and discharge planning processes.

Centene is seeking a Clinical Review Nurse to perform concurrent reviews of inpatient services and evaluate whether the level of care being delivered to members is appropriate and medically necessary. This role supports utilization management processes by reviewing clinical documentation, coordinating with healthcare providers, and contributing to discharge planning to ensure members receive the appropriate care at the right time.

Responsibilities:
- Perform concurrent clinical reviews to evaluate the member’s health status and level of care
- Review inpatient services to validate medical necessity and appropriateness of treatment settings
- Assess acuity levels, length of stay, and discharge planning to ensure continuity of care
- Document review findings, care plans, and related actions within health management systems
- Collaborate with medical directors and healthcare providers regarding treatment decisions
- Provide education and recommendations to providers regarding utilization management guidelines

Requirements:
- Graduate of an accredited school of nursing or Bachelor’s degree in Nursing
- Licensed Practical Nurse (LPN) with active state licensure
- Minimum of 2 to 4 years of related nursing experience
- At least 2 years of acute care clinical experience
- Knowledge of utilization management and healthcare review processes preferred
- Familiarity with Medicare and Medicaid regulations preferred

Benefits:
- Competitive compensation and incentive opportunities
- Health insurance and comprehensive healthcare coverage
- 401(k) retirement plan and stock purchase options
- Tuition reimbursement and professional development programs
- Paid time off and paid holidays
- Flexible remote work environment

This role supports quality healthcare delivery by ensuring members receive appropriate medical services while maintaining compliance with clinical guidelines and utilization management policies.