Remote Utilization Review Nurse

Centene Corporation

California (MO)

Hybrid

CAD 52,000 - 93,000

Full time

5 days ago

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Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Paid time off plus holidays

Job summary

Centene Corporation is seeking a Remote Utilization Review RN to perform concurrent reviews and ensure medically necessary care for members. The role requires a CA RN license and acute care experience, with a Monday–Friday schedule and occasional weekend/holiday rotation.

Responsibilities include documenting findings, coordinating with Medical Affairs, and guiding discharge planning. The position offers competitive pay and comprehensive benefits, with compensation reflecting experience and

Qualifications

Requires RN license with CA registration.
2–4 years of related experience in acute care.
Clinical knowledge to determine health needs and appropriate level of care.

Responsibilities

Performs concurrent reviews to determine appropriate care and setting.
Reviews acuity level, resource use, length of stay, and discharge planning.
Collaborates with Medical Affairs/Medical Directors as needed.
Documents concurrent review findings and discharge plans in health management systems.
Works with providers to approve determinations or provide recommendations.
Educates providers on utilization processes for high‑quality care.
Provides feedback to leadership on opportunities for improvement.
Reviews transfer/discharge plans to ensure timely transitions.
Collaborates with care management on referrals.
Performs other duties and adheres to policies.