Remote Inpatient Utilization Review Nurse

Centene Management Company LLC; Louisiana (MO); Hybrid; USD 37,000 - 68,000; Full time

Benefits offered by this job

Health insurance

401K plan

Stock purchase

Tuition reimbursement

PTO & holidays

Flexible work schedule

Job summary

Centene Management Company LLC is seeking a qualified nurse reviewer to conduct concurrent inpatient and pediatric/adult case reviews to validate medical necessity and appropriate level of care. The position involves documenting findings, coordinating discharge plans, and collaborating with medical leadership to ensure high-quality care for Medicaid members.

Responsibilities include educating providers on utilization processes, sharing feedback with leadership for process improvements, and

Qualifications

• Graduate from an accredited nursing program with licensure.
• 2+ years of acute care experience preferred.
• Knowledge of Medicare and Medicaid regulations is preferred.

Responsibilities

• Perform concurrent reviews to assess appropriateness of care and level of care.
• Collaborate with Medical Affairs/Medical Directors on member care and determinations.
• Document review findings, discharge plans, and actions in health management systems.

Skills

Nursing

Utilization management

Clinical reviews

Inpatient care

Medicare/Medicaid knowledge

Education

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Job description

Centene Management Company LLC is seeking a qualified nurse reviewer to conduct concurrent inpatient and pediatric/adult case reviews to validate medical necessity and appropriate level of care. The position involves documenting findings, coordinating discharge plans, and collaborating with medical leadership to ensure high-quality care for Medicaid members.

Responsibilities include educating providers on utilization processes, sharing feedback with leadership for process improvements, and