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Clinical Review Nurse – Concurrent Review
Centene Corporation. Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical assessment and care management, with a strong focus on utilization management processes and compliance with Medicare and Medicaid regulations. Proven ability to collaborate with healthcare providers and lead initiatives to improve member care and discharge planning.
Highest-signal resume keywords
Acute Care ExperienceUtilization Management ProcessesClinical KnowledgeNursing LicenseDischarge Planning
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Health Management SystemsCare ReviewAcuity Level AssessmentResource Consumption AnalysisMedical Necessity Determination
Soft Skills
CollaborationLeadership FeedbackProvider Education
Certifications & Qualifications
Iowa Nursing LicenseLPN State Licensure
Industry Keywords
Medicare RegulationsMedicaid RegulationsCare ManagementMember ReferralsDischarge Plans
About the role
Key responsibilities & impact- Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care
- Review acuity level, resource consumption, length of stay, and discharge planning
- Work with Medical Affairs and/or Medical Directors to discuss member care
- Collect, document, and maintain review findings, discharge plans, and actions in health management systems
- Work with healthcare providers to approve medical determinations or provide recommendations
- Educate providers on utilization processes
- Provide leadership feedback on opportunities to improve level of care and medical necessity
- Review transfer or discharge plans for timely transitions between levels of care and facilities
- Collaborate with care management on member referrals
- Comply with all policies and standards and perform other assigned duties
Requirements
What you’ll need- Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing
- 2–4 years of related experience
- 2+ years of acute care experience required
- Iowa or compact nursing license
- LPN (Licensed Practical Nurse) state licensure required
- Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred
- Knowledge of Medicare and Medicaid regulations preferred
- Knowledge of utilization management processes preferred
- Availability to work Monday–Friday, 8am–5pm Central
- Participation in a rotating weekend and holiday schedule required
Benefits
Comp & perks- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Competitive pay