Remote Clinical Review Nurse – Utilization Management

Centene Corporation; Arkansas; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Remote work within the United States

Health insurance

401K and stock purchase plans

Job summary

Centene Corporation is seeking a licensed practical nurse (LPN) to analyze prior authorization requests for medical necessity and appropriate care levels. The role supports medical teams, coordinating with providers to ensure timely authorization decisions and proper discharge planning.

The position allows remote work within the United States, with standard full-time hours and periodic weekend coverage to align with patient needs.

Qualifications

• LPN license (state licensure) required.
• Bachelor’s degree in Nursing or graduate from an accredited school of nursing.
• Experience with medical necessity determinations and utilization review preferred.

Responsibilities

• Analyze prior authorization requests for medical necessity and appropriate level of care.
• Collaborate with healthcare providers and authorization team to ensure timely reviews.
• Escalate complex cases to Medical Directors as needed.
• Assist with transfer/discharge planning to maintain timely care transitions.
• Document and maintain clinical information in health management systems in compliance with regulations.

Skills

LPN license

Nursing

Utilization review

Clinical analysis

Education

Bachelor’s degree in Nursing

Job description

Centene Corporation is seeking a licensed practical nurse (LPN) to analyze prior authorization requests for medical necessity and appropriate care levels. The role supports medical teams, coordinating with providers to ensure timely authorization decisions and proper discharge planning.

The position allows remote work within the United States, with standard full-time hours and periodic weekend coverage to align with patient needs.