Remote RN: Utilization Review & Care Coordination

NurseRemotely; United States; Remote; USD 37,000 - 68,000; Full time

Job summary

Centene is seeking a remote Utilization Review Nurse to perform concurrent reviews, determine appropriate levels of care, and support discharge planning for inpatient services. You will collaborate with Medical Affairs and care teams to ensure medically necessary care across multiple states, with a schedule Monday–Friday 8am–5pm in your time zone and occasional weekends/holidays.

The ideal candidate has RN or LPN licensure, 2+ years acute care experience, and knowledge of Medicare/Medicaid

Qualifications

• Graduate from an accredited nursing program with RN or LPN licensure.
• 2+ years of acute care experience preferred.
• Knowledge of Medicare/Medicaid regulations preferred.
• Ability to perform concurrent reviews and discharge planning.

Responsibilities

• Perform concurrent reviews to determine appropriate care level.
• Collaborate with Medical Affairs and Directors on member care.
• Document and maintain review findings and discharge plans.
• Educate providers on utilization processes.
• Support timely discharge between levels of care.
• Comply with policies and standards.

Skills

Acute care experience

Nursing assessment

Utilization management

Education

Bachelor’s in Nursing

Accredited nursing program

Job description

Centene is seeking a remote Utilization Review Nurse to perform concurrent reviews, determine appropriate levels of care, and support discharge planning for inpatient services. You will collaborate with Medical Affairs and care teams to ensure medically necessary care across multiple states, with a schedule Monday–Friday 8am–5pm in your time zone and occasional weekends/holidays.

The ideal candidate has RN or LPN licensure, 2+ years acute care experience, and knowledge of Medicare/Medicaid