Remote Clinical Review Nurse | Utilization & Discharge Planning

Centene Corporation; Illinois; Hybrid; USD 37,000 - 66,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a Nurse to perform concurrent reviews, validate medical necessity, and assist with discharge planning across various care settings. The role requires nursing licensure and acute care experience, with knowledge of Medicare/Medicaid regulations and utilization management.

The position offers a comprehensive benefits package and opportunities to contribute to care quality improvements while supporting member health outcomes.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing.
• 2–4 years of related experience; 2+ years of acute care experience required.
• RN/LPN licensure (state licensure required).
• Knowledge of Medicare and Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.

Responsibilities

• Performs concurrent reviews to determine appropriate care and setting.
• Reviews acuity, resource use, length of stay and discharge planning.
• Collaborates with Medical Affairs/Medical Directors as needed.
• Documents concurrent review findings and discharge plans in health systems.
• Works with providers to approve determinations based on reviews.
• Educates providers on utilization processes to ensure high‑quality care.

Skills

Clinical judgment

Medicare/Medicaid knowledge

Utilization management knowledge

Provider education

Education

Bachelor's degree in Nursing

Graduate from an Accredited School of Nursing

Job description

Centene Corporation is seeking a Nurse to perform concurrent reviews, validate medical necessity, and assist with discharge planning across various care settings. The role requires nursing licensure and acute care experience, with knowledge of Medicare/Medicaid regulations and utilization management.

The position offers a comprehensive benefits package and opportunities to contribute to care quality improvements while supporting member health outcomes.