Remote RN - Clinical Utilization & Discharge Review

Centene Corporation; Sacramento (CA); Remote; 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 work schedules (remote/hybrid

Remote, hybrid, field or office work

Job summary

Centene Corporation is seeking a remotely based Registered Nurse to perform concurrent reviews, assess acuity, and validate medical necessity across care settings. The role requires CA licensure and a Nursing degree with 2–4 years of related experience, including acute care.

You will collaborate with Medical Affairs and providers to ensure timely, appropriate care for members. Responsibilities include documenting findings, assisting with discharge planning, and educating providers on utilization

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing.
• 2–4 years of related experience; 2+ years of acute care experience.

Responsibilities

• Performs concurrent reviews to determine appropriate level of care and overall health.
• Reviews acuity level, resource use, length of stay and discharge planning.
• Collaborates with Medical Affairs/Directors to discuss member care.
• Documents findings and discharge plans in health management systems.
• Educates providers on utilization processes to ensure quality care.
• Provides feedback to leadership on opportunities to improve care suitability.

Skills

Clinical knowledge

Education

Bachelor's degree in Nursing

Graduate from an Accredited School of Nursing

Job description

Centene Corporation is seeking a remotely based Registered Nurse to perform concurrent reviews, assess acuity, and validate medical necessity across care settings. The role requires CA licensure and a Nursing degree with 2–4 years of related experience, including acute care.

You will collaborate with Medical Affairs and providers to ensure timely, appropriate care for members. Responsibilities include documenting findings, assisting with discharge planning, and educating providers on utilization