Remote Utilization Review Nurse – Acute Care Expert

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

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Management Company LLC is seeking a licensed nurse to perform concurrent reviews for appropriate care and setting, evaluating medical necessity, and supporting discharge planning in a fully remote role. You will work weekdays with a rotating weekend schedule and collaborate with Medical Affairs and care teams.

Ideal candidates have 2–4 years of acute care nursing experience, knowledge of Medicare/Medicaid regulations, and prior UM/CM exposure.

Qualifications

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

Responsibilities

• Performs concurrent reviews to determine appropriate care and setting.
• Reviews quality and discharge planning, acuity level, resource use, and length of stay.
• Collaborates with Medical Affairs/Medical Directors on member care.

Skills

Acute care nursing experience

Utilization Management experience

Education

Graduate from Accredited School of Nursing

Bachelor's degree in Nursing

Job description

Centene Management Company LLC is seeking a licensed nurse to perform concurrent reviews for appropriate care and setting, evaluating medical necessity, and supporting discharge planning in a fully remote role. You will work weekdays with a rotating weekend schedule and collaborate with Medical Affairs and care teams.

Ideal candidates have 2–4 years of acute care nursing experience, knowledge of Medicare/Medicaid regulations, and prior UM/CM exposure.