Concurrent Review Nurse II

Centene

Job Details

Location: Tempe, Maricopa County, Arizona, USA Posted: Dec 31, 2019

Job Description

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 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

Direct care to participating network providers

Participate in utilization management committees and work on special projects related to utilization management as needed

For New Hampshire and Massachusetts - home visits required

About Centene

Centene is a multi-line health care enterprise offering Medicaid managed care and specialty services.

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