Remote Utilization Review Nurse - Clinical Care Specialist

Centene Corporation; North Carolina; Remote; USD 37,000 - 67,000; Full time

Job summary

Centene Corporation is seeking a fully remote Utilization Management/Case Management nurse to perform concurrent reviews, discharge planning, and medical necessity assessments. The role requires 2+ years of acute care nursing and prior UM/CM experience is a plus.

The position offers a Monday–Friday schedule with rotating weekends. Responsibilities include reviewing acuity, documenting findings in health management systems, collaborating with Medical Affairs, and providing education to providers

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing with 2–4 years of related experience.
• 2+ years of acute care experience required.
• Clinical knowledge to determine overall health and level of care preferred.

Responsibilities

• Perform concurrent reviews to determine appropriate care and level of care.
• Review acuity, resource use, length of stay, and discharge planning.
• Collaborate with Medical Affairs/Directors on member care.
• Document findings in health management systems per UM policies.
• Educate providers on utilization processes.

Skills

Acute care nursing

Utilization management

Clinical assessment

Provider education

Education

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Tools

Health management systems

Job description

Centene Corporation is seeking a fully remote Utilization Management/Case Management nurse to perform concurrent reviews, discharge planning, and medical necessity assessments. The role requires 2+ years of acute care nursing and prior UM/CM experience is a plus.

The position offers a Monday–Friday schedule with rotating weekends. Responsibilities include reviewing acuity, documenting findings in health management systems, collaborating with Medical Affairs, and providing education to providers