Remote Concurrent Review RN — Utilization Management (MO)

Centene Corporation; Missouri; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote/hybrid

Job summary

Centene Corporation seeks a Registered Nurse to perform concurrent reviews for members in Missouri. The position is fully remote with MO residency and MO licensure required. Work hours are Monday–Friday, 8am–5pm CT, with 1–2 holiday rotations per year.

The role emphasizes assessing health status, care settings, medical necessity, and discharge planning, in collaboration with Medical Directors and care teams.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing.
• 2–4 years of related experience; 2+ years acute care experience required.
• Knowledge of Medicare/Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.

Responsibilities

• Performs concurrent reviews to determine appropriate level of care and health status.
• Reviews acuity, resource use, length of stay, and discharge planning.
• Collaborates with Medical Affairs/Medical Directors as needed.
• Documents and maintains concurrent review findings and discharge plans.
• Assists providers with approvals and recommendations based on reviews.
• Educates providers on utilization processes to ensure quality care.
• Provides feedback to leadership on opportunities to improve care alignment.
• Assesses transfer/discharge plans for timely care transitions.
• Partners with care management on referrals when appropriate.

Skills

Clinical knowledge

Utilization management

Medicare/Medicaid regs

MO RN licensure

Education

Bachelor’s degree in Nursing

Accredited Nursing program graduate

2–4 years related experience

2+ years acute care

Job description

Centene Corporation seeks a Registered Nurse to perform concurrent reviews for members in Missouri. The position is fully remote with MO residency and MO licensure required. Work hours are Monday–Friday, 8am–5pm CT, with 1–2 holiday rotations per year.

The role emphasizes assessing health status, care settings, medical necessity, and discharge planning, in collaboration with Medical Directors and care teams.