Clinical Review Nurse - Concurrent Review

About This Gig

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 benefits including a fresh perspective on workplace flexibility. Seeking a remote Clinical Review Nurse to perform UM Clinical reviews for post-acute levels of care (Skilled Nursing, Inpatient Rehab, LTACH) utilizing medical necessity tools (InterQual) and clinical policies. Candidates in CST or MST are highly preferred Position 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 healt

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