Remote Clinical Review Nurse - Utilization Management

Centene Corporation; Kansas City (MO); Remote; USD 60,000 - 85,000; Full time

Job summary

Centene Corporation is seeking a Nurse (LPN or RN) to analyze prior authorization requests for medical necessity and appropriate level of care. The role emphasizes collaboration with medical teams to promote quality and cost effectiveness, while ensuring regulatory compliance.

Applicants may work remotely from anywhere in the United States. This full-time position requires weekday hours with occasional weekend coverage and holidays, supporting timely discharge planning and member care

Qualifications

• Graduate from an Accredited School of Nursing or a Bachelor's degree in Nursing.
• 2–4 years of related experience preferred.
• Knowledge of Medicare/Medicaid regulations and utilization management preferred.

Responsibilities

• Analyzes medical necessity and clinical reviews of authorization requests.
• Determines appropriate level of care in line with standards and member benefits.
• Collaborates with providers and authorization team for timely reviews.
• Escalates to Medical Directors when appropriate.
• Educates providers and interdepartmental teams on utilization processes.
• Maintains clinical information in health management systems.

Skills

Clinical knowledge

Regulatory knowledge

Communication

Education

Graduate from Accredited School of Nursing

Bachelor's degree in Nursing

Tools

Health management systems

Job description

Centene Corporation is seeking a Nurse (LPN or RN) to analyze prior authorization requests for medical necessity and appropriate level of care. The role emphasizes collaboration with medical teams to promote quality and cost effectiveness, while ensuring regulatory compliance.

Applicants may work remotely from anywhere in the United States. This full-time position requires weekday hours with occasional weekend coverage and holidays, supporting timely discharge planning and member care