Clinical Review Nurse - Hybrid/Remote Utilization Management

Centene Corporation; Austin (TX); On-site; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Flexible work schedules

Job summary

Centene seeks a licensed nurse to perform concurrent reviews of inpatient admissions for pediatric and adult members within the LA Medicaid line of business. The role focuses on determining medical necessity and appropriate level of care, with standard hours 8am to 5pm CST and weekend/holiday rotation.

Requires a nursing degree and state licensure with 2+ years of acute care experience. Knowledge of Medicare/Medicaid regulations and utilization management is preferred.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing.
• 2–4 years of related experience in nursing.
• 2+ years of acute care experience.
• Knowledge of Medicare and Medicaid regulations preferred.

Responsibilities

• Perform concurrent reviews of inpatient admissions to validate necessity and level of care.
• Collect, document, and maintain concurrent review findings and discharge plans.
• Collaborate with Medical Affairs and care management on recommendations.
• Educate providers on utilization processes to ensure high-quality care.
• Ensure timely discharge planning between levels of care and facilities.

Skills

Clinical reviews

Acute care

Utilization management

Medicare/Medicaid

Education

Bachelor's degree in Nursing

Job description

Centene seeks a licensed nurse to perform concurrent reviews of inpatient admissions for pediatric and adult members within the LA Medicaid line of business. The role focuses on determining medical necessity and appropriate level of care, with standard hours 8am to 5pm CST and weekend/holiday rotation.

Requires a nursing degree and state licensure with 2+ years of acute care experience. Knowledge of Medicare/Medicaid regulations and utilization management is preferred.