Remote NICU Utilization Review Nurse

Centene Management Company LLC; United States; Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Management Company LLC in the United States seeks a nurse to perform concurrent reviews, assess member health, determine appropriate care settings, validate medical necessity, and contribute to discharge planning in line with care policies.

Ideal candidates have neonatal NICU experience (level II or IV), compact or multi-state licensure, an RN or LPN license, and 2+ years of acute care. The role offers remote work with a Mon-Fri schedule and rotating weekends/holidays.

Qualifications

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

Responsibilities

• Perform concurrent reviews to determine appropriate care and level of care.
• Collaborate with Medical Affairs/Medical Directors on member care.
• Document concurrent review findings and discharge plans in health systems.
• Educate providers on utilization processes to ensure quality care.
• Support timely discharge and transfer planning.

Skills

NICU experience

Multi-state licensure

Utilization review knowledge

Education

Nursing degree (RN or LPN)

Tools

Health management systems

Job description

Centene Management Company LLC in the United States seeks a nurse to perform concurrent reviews, assess member health, determine appropriate care settings, validate medical necessity, and contribute to discharge planning in line with care policies.

Ideal candidates have neonatal NICU experience (level II or IV), compact or multi-state licensure, an RN or LPN license, and 2+ years of acute care. The role offers remote work with a Mon-Fri schedule and rotating weekends/holidays.