Remote Clinical Utilization Review Nurse - Discharge

Centene Management Company LLC; Arizona; Hybrid; USD 37,000 - 68,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible approach to work with remote,

hybrid, field or office work schedules

Job summary

Centene Management Company LLC is seeking a remote nurse reviewer to assess concurrent care and determine appropriate levels of care for members across multiple states, including Arizona. The role involves collaboration with Medical Affairs and providers, and requires strong clinical judgment and knowledge of utilization management processes.

Candidates should have a nursing degree and 2+ years of acute care experience, with RN licensure preferred and potential multi-state licensure eligibility.

Qualifications

• Graduate from an accredited nursing school or a BSN.
• 2–4 years of related experience; 2+ years acute care preferred.
• RN licensure; multi-state licensure eligibility preferred (Nevada, etc.).
• Knowledge of Medicare/Medicaid regulations and utilization processes.

Responsibilities

• Perform concurrent reviews to determine appropriate level of care.
• Review acuity, resource use, length of stay, and discharge planning.
• Collaborate with Medical Affairs/Medical Directors as needed.
• Educate providers on utilization processes to ensure quality care.
• Maintain review findings and discharge plans in health management systems.
• Assist with timely discharge across levels of care.
• Perform other duties as assigned.

Skills

Clinical knowledge

Communication skills

RN licensure preferred

Education

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Tools

Health management systems

Utilization review software

Job description

Centene Management Company LLC is seeking a remote nurse reviewer to assess concurrent care and determine appropriate levels of care for members across multiple states, including Arizona. The role involves collaboration with Medical Affairs and providers, and requires strong clinical judgment and knowledge of utilization management processes.

Candidates should have a nursing degree and 2+ years of acute care experience, with RN licensure preferred and potential multi-state licensure eligibility.