Remote Utilization Review Nurse

centene; Iowa (LA); Remote; USD 77,468,000 - 139,116,000; Full time

Job summary

Centene is seeking a Nursing professional to perform concurrent reviews from a home-based setting, ensuring appropriate care levels and discharge planning. Requires an Iowa license (or compact) and nursing degree with 2–4 years of related experience, including acute care exposure.

The role includes coordinating with Medical Affairs and educating providers on utilization processes. Schedule is Mon-Fri, 8am-5pm Central with rotating weekends/holidays.

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.
• Knowledge of Medicare and Medicaid regulations and utilization management preferred.

Responsibilities

• Perform concurrent reviews to assess appropriate care level.
• Review acuity, resources, length of stay, and discharge planning.
• Collaborate with Medical Affairs/Medical Directors on member care.

Skills

Clinical knowledge

Communication skills

Education

Bachelor's degree in Nursing

Job description

Centene is seeking a Nursing professional to perform concurrent reviews from a home-based setting, ensuring appropriate care levels and discharge planning. Requires an Iowa license (or compact) and nursing degree with 2–4 years of related experience, including acute care exposure.

The role includes coordinating with Medical Affairs and educating providers on utilization processes. Schedule is Mon-Fri, 8am-5pm Central with rotating weekends/holidays.