Remote RN: Utilization & Discharge Review Specialist

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

Benefits offered by this job

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off

Job summary

Centene Management Company LLC is seeking a licensed nurse to perform concurrent reviews for Ambetter members in Georgia. This fully remote role follows a Monday–Friday schedule 8am–5pm ET and supports medically necessary care decisions.

The position requires RN/LPN licensure with nursing education and 2+ years acute care experience; knowledge of utilization management is preferred. This role offers remote flexibility and contributes to value-based care.

Qualifications

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

Responsibilities

• Perform concurrent reviews to determine appropriate care and setting.
• Assess member health and level of care; collaborate with Medical Affairs/Directors.
• Document concurrent review findings and discharge plans in health management systems.
• Collaborate with healthcare providers to approve determinations or provide recommendations.
• Educate providers on utilization processes to ensure quality care.
• Review transfer or discharge plans for timely transitions.
• Assist with referrals to care management as appropriate.
• Adhere to policies and standards.

Skills

Clinical assessment

Care coordination

Documentation

Communication

Education

Bachelor's degree in Nursing

Job description

Centene Management Company LLC is seeking a licensed nurse to perform concurrent reviews for Ambetter members in Georgia. This fully remote role follows a Monday–Friday schedule 8am–5pm ET and supports medically necessary care decisions.

The position requires RN/LPN licensure with nursing education and 2+ years acute care experience; knowledge of utilization management is preferred. This role offers remote flexibility and contributes to value-based care.