Remote Clinical Review Nurse - Utilization & Discharge

centene; California (MO); Hybrid; CAD 53,000 - 95,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401(k) and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible remote/hybrid/office options

Job summary

Centene seeks an experienced RN to perform concurrent reviews, assess care levels, and support discharge planning for members in a remote California role. The position requires a California RN license and 2+ years in acute care, with 2–4 years of related utilization management experience.

You will collaborate with Medical Affairs and providers, document findings, and educate teams on utilization processes to maintain high-quality, cost-effective care.

Qualifications

• RN licensed in California.
• Bachelor's degree in Nursing from an accredited program.
• 2–4 years of related experience; 2+ years in acute care.

Responsibilities

• Performs concurrent reviews to determine appropriate level of care and setting.
• Reviews quality and continuity of care by assessing acuity, resource use, length of stay, and discharge planning.
• Collaborates with Medical Affairs/Medical Directors on member care discussions.
• Documents findings, discharge plans, and actions in health management systems per utilization policies.
• Interacts with healthcare providers to support medical determinations.
• Educates providers on utilization processes to ensure high-quality care.
• Gives feedback to leadership on opportunities to improve appropriate care levels.
• Reviews transfer/discharge plans to ensure timely transitions between facilities.
• Collaborates on member referrals with care management.
• Performs other duties as assigned and complies with policies.

Skills

RN license

Acute care

Utilization management

Care coordination

Education

Bachelor's degree in Nursing

Job description

Centene seeks an experienced RN to perform concurrent reviews, assess care levels, and support discharge planning for members in a remote California role. The position requires a California RN license and 2+ years in acute care, with 2–4 years of related utilization management experience.

You will collaborate with Medical Affairs and providers, document findings, and educate teams on utilization processes to maintain high-quality, cost-effective care.