Remote Clinical Review Nurse — Utilization & Discharge Advocate

Centene Corporation; Lansing (MI); Remote; USD 37,000 - 68,000; Full time

Job summary

Centene Corporation is seeking a Nurse Reviewer for remote work in the United States. The role involves performing concurrent reviews to determine appropriate level of care and discharge planning, with emphasis on medical necessity and care setting.

Requires active Nursing license and acute care experience. Ideal candidates will have knowledge of Medicare/Medicaid regulations and experience with health management systems.

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.
• Clinical knowledge to determine member health and level of care.
• Knowledge of Medicare/Medicaid regulations preferred.

Responsibilities

• Perform concurrent reviews to determine appropriate care and setting.
• Review acuity, resource use, LOS, and discharge planning.
• Collaborate with Medical Affairs/Medical Directors on member care decisions.
• Document findings and discharge plans in health management systems.
• Educate providers on utilization processes to ensure quality care.
• Provide feedback to leadership on opportunities to improve care levels and necessity.

Skills

Nursing license

Clinical review

Utilization management

Hospital experience

Education

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Tools

EMR systems

Job description

Centene Corporation is seeking a Nurse Reviewer for remote work in the United States. The role involves performing concurrent reviews to determine appropriate level of care and discharge planning, with emphasis on medical necessity and care setting.

Requires active Nursing license and acute care experience. Ideal candidates will have knowledge of Medicare/Medicaid regulations and experience with health management systems.