Remote RN: Medicaid Utilization Review Nurse

Centene Management Company LLC; Illinois; Híbrido; USD 37 000 - 67 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health insurance

401K and stock purchase plans

tuition reimbursement

paid time off plus holidays

flexible approach to work with remote,

Resumo da oferta

Centene Management Company LLC is seeking an RN for remote utilization management supporting Illinois Medicaid and Ambetter. The role is full-time with standard hours Mon-Fri 8am-5pm CT, with rotating weekends and holidays.

The RN will perform concurrent reviews to assess care needs, validate medical necessity, and contribute to discharge planning. Illinois licensure is required; prior acute care and knowledge of Medicaid guidelines are preferred.

Qualificações

• 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.
• Knowledge of utilization management processes preferred.

Responsabilidades

• Perform concurrent reviews to determine appropriate care and setting.
• Review acuity level, resource use, length of stay, and discharge planning.
• Collaborate with Medical Affairs and/or Medical Directors as needed.
• Document concurrent review findings, discharge plans, and actions in health management systems.
• Educate providers on utilization processes to ensure high quality care.
• Provide feedback to leadership on opportunities to improve appropriate level of care.
• Review transfer or discharge plans for timely discharge between levels of care.
• Collaborate with care management on referrals.

Formação académica

Graduate from an Accredited School of Nursing

Bachelor’s degree in Nursing

Descrição da oferta de emprego

Centene Management Company LLC is seeking an RN for remote utilization management supporting Illinois Medicaid and Ambetter. The role is full-time with standard hours Mon-Fri 8am-5pm CT, with rotating weekends and holidays.

The RN will perform concurrent reviews to assess care needs, validate medical necessity, and contribute to discharge planning. Illinois licensure is required; prior acute care and knowledge of Medicaid guidelines are preferred.