Remote Clinical Utilization Review Nurse

Centene Management Company LLC; California (MO); Hybrid; USD 40,000 - 66,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off

Flexible work options

Job summary

Centene Management Company LLC is seeking an experienced RN to perform concurrent reviews, assess overall member health, and determine the appropriate level of care in a remote California-based role. The position follows care policies, supports discharge planning, and collaborates with Medical Affairs and providers to ensure high-quality, efficient care for members.

The ideal candidate holds a California RN license, a BSN or nursing degree, and 2–4 years of acute care experience, with knowledge

Qualifications

• Graduate from an accredited nursing program or BSN with 2–4 years of related experience.
• Minimum 2+ years of acute care experience.
• Knowledge of Medicare and Medicaid regulations and utilization management preferred.

Responsibilities

• Perform concurrent reviews to validate need and level of care.
• Collaborate with Medical Affairs/Directors on member care.
• Educate providers on utilization processes to ensure appropriate care.
• Document findings and discharge plans in health management systems.

Skills

Clinical assessment

Utilization management

Medicare/Medicaid knowledge

Acute care experience

Education

Bachelor’s degree in Nursing

Graduate from an Accredited School of Nursing

California RN license

Job description

Centene Management Company LLC is seeking an experienced RN to perform concurrent reviews, assess overall member health, and determine the appropriate level of care in a remote California-based role. The position follows care policies, supports discharge planning, and collaborates with Medical Affairs and providers to ensure high-quality, efficient care for members.

The ideal candidate holds a California RN license, a BSN or nursing degree, and 2–4 years of acute care experience, with knowledge