NEW
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.This position is a remote opportunity and can be within an eastern or central time zone.Position Purpose: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.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 determinationsComplete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findingsCollaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member careConduct discharge planningEducate providers on utilization and medical management processesProvide clinical knowledge and act as a clinical resource to non-clinical team staffEnter and maintain pertinent clinical information in various medical management systemsQualifications: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.***This position requires weekends and will have a shift differential***Our Comprehensive Benefits Package:Flexible work solutions including remote options, hybrid work schedules and dress flexibilityCompetitive payPaid Time Off including paid holidaysHealth insurance coverage for you and dependents401(k) and stock purchase plansTuition reimbursement and best-in-class training and developmentCentene 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.
Location/Region: Tampa, FL (33694)