Clinical Utilization Review Nurse (MS)

Centene Management Company LLC; Mississippi; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K

Stock plans

Tuition reimbursement

Paid time off

Holidays

Flexible work schedule

Job summary

Centene Management Company LLC in Mississippi is recruiting a Utilization Management Nurse to perform concurrent reviews, assess member health, and determine the appropriate level of care. You will collaborate with Medical Affairs to validate care plans and support discharge planning within utilization management guidelines.

The role requires nursing licensure and acute care experience, with education aligned to RN or LPN pathways.

Qualifications

• Graduate from an Accredited School of Nursing or BSN with 2–4 years of related experience.
• 2+ years of acute care experience required.
• Clinical knowledge to determine overall health and appropriate level of care.
• Knowledge of utilization management processes preferred.

Responsibilities

• Performs concurrent reviews to determine medical necessity and level of care.
• Reviews inpatient admissions and elective procedures for care appropriateness.
• Collaborates with Medical Affairs/Medical Directors on member care decisions.
• Collects and documents concurrent review findings and discharge plans.
• Educates providers on utilization processes to ensure quality care.
• Supports discharge planning and timely transitions between care settings.
• Assists with referral and care management processes as needed.

Education

Graduate from an Accredited School of Nursing

Bachelor’s degree in Nursing

Job description

Centene Management Company LLC in Mississippi is recruiting a Utilization Management Nurse to perform concurrent reviews, assess member health, and determine the appropriate level of care. You will collaborate with Medical Affairs to validate care plans and support discharge planning within utilization management guidelines.

The role requires nursing licensure and acute care experience, with education aligned to RN or LPN pathways.