locations
Remote-TX
San Antonio - 7990 IH 10 West - Ste 300 (Superior) (10089)
Lubbock - 7202 Slide Rd (Superior) (10088)
Corpus Christi - 711 N. Carancahua St., Ste 600 (Superior) (10086)
McAllen - 3900 North 10th St (10123)
View All 7 Locations
time type
Full time
posted on
Posted Today
job requisition id
1569464
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.
Work Schedule: Monday - Friday: 8:00 am - 5:00 pm (CST)
Position required to work in Central Time Zone
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 health and appropriate level of care
Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member
Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered
Collects, 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 guidelines
Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings
Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members
Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines
Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities
Collaborates with care management on referral of members as appropriate
Performs other duties as assigned
Complies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred.
License/Certification:
LPN - Licensed Practical Nurse - State Licensure is required
RN - Registered Nurse - State Licensure and/or Compact Nursing Licensure is required
Preferred Experience:
3+ years’ of direct patient care experience as a Registered Nurse (RN) in Acute Care – Trauma, Critical Care, ICU, ER, Cardiac, L & D, Med/Surg, OR, Oncology, OB/Gyn, Military, LTC, SNF, Surgery, Telemetry, Triage Nursing, Urgent Care, and/or Women’s Health
3+ years of clinical nursing experience with all patient populations (0 – 65+) providing care coordination, D/C planning, patient and family education, and patient safety
Role requires clinical experience, knowledge, and the ability to determine overall health of members, including treatment needs and appropriate level of care
Knowledge of Concurrent Review, Utilization Management processes, Medicare, Medicaid, and Managed Care is preferred
Strong computer skills and experience working within multiple CMS and EMR databases
Strong multi-tasking and critical thinking skills required in this role to communicate with Medical Directors, clinical staff, members, and providers
Must be able to navigate between multiple screens, Microsoft Office applications and utilize multiple avenues of communication (e.g. phone queue, MS Teams, email, video conferencing) - 90% of the role responsibilities.
Pay Range: $26.50 - $47.59 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act