Remote RN - Utilization & Concurrent Review Specialist

Centene Corporation; Pennsylvania; Hybrid; USD 37,000 - 67,000; Full time

Job summary

Centene Corporation seeks a Registered Nurse to perform concurrent reviews, determine member health status, evaluate medical necessity, and contribute to discharge planning according to policies. This remote role supports inpatient services assessment and collaboration with care teams to ensure appropriate care settings.

The ideal candidate has an accredited nursing degree, 2–4 years of related acute care experience, and familiarity with Medicare/Medicaid regulations.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor of Science in Nursing.
• 2–4 years of related experience, with at least 2+ years in acute care.
• Knowledge of Medicare/Medicaid regulations preferred.

Responsibilities

• Performs concurrent reviews to determine appropriate care and setting.
• Reviews quality and discharge planning based on acuity, resource use, and LOS.
• Collaborates with Medical Affairs/Medical Directors regarding member care.
• Documents findings and actions in health management systems per policies.
• Assists providers with approvals or recommendations based on reviews.
• Educates providers on utilization processes for high-quality care.
• Provides feedback to leadership on care level improvements.
• Reviews transfer or discharge plans to ensure timely transitions.
• Collaborates with care management on member referrals.
• Performs other duties and complies with policies.

Skills

Clinical knowledge

Acute care experience

Communication

Education

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Tools

Health management systems

Job description

Centene Corporation seeks a Registered Nurse to perform concurrent reviews, determine member health status, evaluate medical necessity, and contribute to discharge planning according to policies. This remote role supports inpatient services assessment and collaboration with care teams to ensure appropriate care settings.

The ideal candidate has an accredited nursing degree, 2–4 years of related acute care experience, and familiarity with Medicare/Medicaid regulations.