Concurrent Review Nurse I
Company: Home State Health Plan
Location: Nixa
Posted on: June 25, 2022
Job Description:
***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.Position
Purpose: -
- 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
other determinations
- 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
processes
- 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
- Competitive pay
- Paid Time Off including paid holidays
- Health insurance coverage for you and dependents
- 401(k) and stock purchase plansTuition reimbursement and
best-in-class training and developmentPromote 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 reviews.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, Springfield , Concurrent Review Nurse I, Healthcare , Nixa, Missouri
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