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Company Name : Superior HealthPlan
Location : Texas
Position : Concurrent Review Nurse I
Job Description : You could be the one who changes everything for our 25 million members as a Concurrent Review Nurse I on the Clinical team. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national Fortune 24 and rapidly growing organization, exceptional talent fuels our mission.
Do you thrive in a supportive, result-oriented community and are committed to the relentless pursuit of continuous growth? As part of our clinical group, the member-focused care you deliver will make a difference and change the face of healthcare for Texas. Are you ready to make an impact?
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
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 reviews.
Requirements:
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.
Benefits & Perks:
Flexible work solutions, including work from home and telecommuting
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 development
In-person and virtual training following State and Community guidelines
Licenses/Certifications: Current state’s RN license.
About Centene:
We are an industry leader with a local focus and a global vision:
We are a diversified, multi-national, inclusive healthcare company delivering relevant, technology-driven solutions at the global, national, and local levels
Listed on Fortune magazine’s World’s Most Admired Companies List for 2nd consecutive year
National footprint across all 50 states, serving 1 in 15 individuals in the U.S.
Recognized as one of the Best Places to Work by the Human Rights Campaign Foundation
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.
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