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Concurrent Review Nurse I

Company: Centene Coproration
Location: Harrisburg
Posted on: December 4, 2019

Job Description:

Description: Position Purpose: 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 For New Hampshire and Massachusetts - home visits required

Keywords: Centene Coproration, Harrisburg , Concurrent Review Nurse I, Healthcare , Harrisburg, Pennsylvania

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