Centene Corporation Concurrent Review Nurse II in El Centro, California

HourlyPosition 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 systemsDirect care to participating network providersParticipate in utilization management committees and work on special projects related to utilization management as neededFor New Hampshire and Massachusetts - home visits required

TITLE: Concurrent Review Nurse II

LOCATION: El Centro, California

REQNUMBER: 1091838

COMPANY: Clinical & Nursing