Remote NICU Utilization Review Nurse

Centene Corporation; Oklahoma; Hybrid; USD 70,000 - 90,000; Full time

Job summary

Centene Corporation is seeking qualified nurses to perform concurrent reviews, determine appropriate care levels, and support discharge planning for members. The role emphasizes collaboration with Medical Affairs and providers to ensure medically necessary, high‑quality care and adherence to utilization guidelines.

Ideal candidates have an accredited nursing degree, 2+ years acute care experience, and familiarity with Medicare/Medicaid regulations.

Qualifications

• Graduate from an accredited school of nursing or have a Bachelor’s degree in Nursing with 2–4 years of related experience.
• 2+ years of acute care experience is required.
• Knowledge of Medicare and Medicaid regulations is preferred.
• Knowledge of utilization management processes is preferred.

Responsibilities

• Performs concurrent reviews to determine appropriate level of care and setting.
• Reviews quality and discharge planning including acuity, resource use, and length of stay.
• Collaborates with Medical Affairs/Directors on member care decisions.
• Documents findings and actions in health management systems per utilization policies.
• Educates providers on utilization processes to ensure high‑quality care.

Skills

Acute care

Utilization review

Discharge planning

Provider education

Interdisciplinary collaboration

Education

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Job description

Centene Corporation is seeking qualified nurses to perform concurrent reviews, determine appropriate care levels, and support discharge planning for members. The role emphasizes collaboration with Medical Affairs and providers to ensure medically necessary, high‑quality care and adherence to utilization guidelines.

Ideal candidates have an accredited nursing degree, 2+ years acute care experience, and familiarity with Medicare/Medicaid regulations.