Remote Clinical Review Nurse | Utilization Management

Centene Corp.; Northern (KY); Hybrid; USD 37,000 - 66,000; Full time

Job summary

Centene Corp. is seeking a Clinical Review Nurse for concurrent reviews in a fully remote role, supporting Medicaid and Marketplace members.

Requires RN or LPN licensure, nursing degree, and 2+ years acute care experience; compact licensure preferred. You will assess level of care, medical necessity, discharge planning, and collaborate with Medical Affairs to ensure high-quality, appropriate care.

Work hours are 8am-5pm in your time zone, Monday to Friday, with rotational Saturdays and holidays.

Qualifications

• Graduate from an Accredited School of Nursing or a Bachelor’s degree in Nursing.
• 2+ years of acute care experience is required.
• LPN or RN licensure; compact state licensure preferred.

Responsibilities

• Performs concurrent reviews to determine overall health and appropriate level of care.
• Reviews acuity, resource use, length of stay and discharge planning.
• Collaborates with Medical Affairs/Medical Directors on member care decisions.
• Documents findings and discharge plans in health management systems.

Education

Nursing degree (RN or LPN)

Job description

Centene Corp. is seeking a Clinical Review Nurse for concurrent reviews in a fully remote role, supporting Medicaid and Marketplace members.

Requires RN or LPN licensure, nursing degree, and 2+ years acute care experience; compact licensure preferred. You will assess level of care, medical necessity, discharge planning, and collaborate with Medical Affairs to ensure high-quality, appropriate care.

Work hours are 8am-5pm in your time zone, Monday to Friday, with rotational Saturdays and holidays.