Clinical Review Nurse - Concurrent Review

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team.

Centene is a diversified, national organization offering competitive.

Beneficios

This position has on call weekend and holiday rotationsPosition Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines.

Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.

• Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of careReviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of memberWorks with Medical Affairs and/or Medical Directors as needed to discuss member care being deliveredCollects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelinesWorks with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findingsAssists with providing education to providers on utilization processes to ensure high quality appropriate care to membersProvides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelinesReviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilitiesCollaborates with care management on referral of members as appropriatePerforms other duties as assigned.

Complies with all policies and standards.

Education/Experienc.