Remote RN: Concurrent Review & Utilization Management

Centene Management Company LLC; North Carolina; Hybrid; USD 37,000 - 67,000; Full time

Job summary

Centene is seeking a nurse to perform concurrent reviews and determine the appropriate level of care for members in a fully remote role. You will evaluate inpatient services, assist with discharge planning, and collaborate with medical leaders to support necessary care choices.

Requirements include RN/LPN licensure and 2+ years in acute care, with knowledge of Medicare/Medicaid regulations and utilization management. Remote schedule Monday–Friday with rotating weekends is offered.

Qualifications

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

Responsibilities

• Perform concurrent reviews to assess appropriate level of care.
• Collaborate with Medical Affairs/Directors on patient care decisions.
• Document findings and discharge plans in health management systems.
• Educate providers on utilization processes to ensure high quality care.
• Support timely discharge planning and transfers between levels of care.
• Maintain compliance with policies and standards.

Skills

Acute care nursing

Utilization management

Case management

Clinical assessment

Education

Graduate from Accredited School of Nursing

Bachelor’s degree in Nursing

Tools

Health management systems

Job description

Centene is seeking a nurse to perform concurrent reviews and determine the appropriate level of care for members in a fully remote role. You will evaluate inpatient services, assist with discharge planning, and collaborate with medical leaders to support necessary care choices.

Requirements include RN/LPN licensure and 2+ years in acute care, with knowledge of Medicare/Medicaid regulations and utilization management. Remote schedule Monday–Friday with rotating weekends is offered.