Remote Clinical Review Nurse - Utilization & Discharge

Centene Corporation; Pennsylvania; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Remote/hybrid work options

Job summary

Centene Corporation is seeking a Licensed Practical Nurse (LPN) or Registered Nurse (RN) for a remote case management role in Pennsylvania. The selected candidate will perform concurrent reviews, determine appropriate care levels, and assist with discharge planning to support patient health and care coordination.

Requirements include an active Pennsylvania or Compact State license and 2–4 years of acute care experience.

Qualifications

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

Responsibilities

• Performs concurrent reviews to determine appropriate care and setting.
• Reviews quality and continuity of care including discharge planning and length of stay.
• Collaborates with Medical Affairs/Medical Directors on member care.
• Documents review findings and discharge plans in health management systems.
• Works with providers to approve determinations based on findings.
• Educates providers on utilization processes to ensure high-quality care.
• Provides leadership feedback to improve appropriate level of care and necessity.
• Reviews transfer/discharge plans for timely transitions.
• Collaborates with care management on member referrals.
• Performs other duties and complies with policies.

Skills

Clinical knowledge

Education

Graduate from an Accredited School of Nursing

Bachelor’s degree in Nursing

2–4 years of related experience

Job description

Centene Corporation is seeking a Licensed Practical Nurse (LPN) or Registered Nurse (RN) for a remote case management role in Pennsylvania. The selected candidate will perform concurrent reviews, determine appropriate care levels, and assist with discharge planning to support patient health and care coordination.

Requirements include an active Pennsylvania or Compact State license and 2–4 years of acute care experience.