Remote Utilization Review Nurse — Inpatient & Discharge

Centene Corporation; Jackson (MS); On-site; USD 37,000 - 67,000; Full time

Job summary

Centene Corporation in Mississippi is seeking a Nurse Utilization Management professional to review inpatient admissions and concurrent care for medical necessity. The role supports the Magnolia Health Plan Utilization Management team and ensures appropriate care levels.

You will assess overall patient health, coordinate with medical leaders, and document outcomes in health systems, contributing to discharge planning and care optimization.

Qualifications

• Requires Nursing degree and licensure.
• 2–4 years related experience.
• 2+ years acute care experience preferred.
• Knowledge of Medicare/Medicaid/utilization management helpful.

Responsibilities

• Performs concurrent reviews to assess care level and medical necessity.
• Reviews acuity, resource use, length of stay, and discharge planning.
• Collaborates with Medical Affairs/Directors on member care.
• Documents findings and discharge plans in health systems.
• Interacts with providers to approve or advise on services.
• Educates providers on utilization processes to ensure quality care.
• Gives leadership feedback to improve appropriate care levels.
• Reviews transfer/discharge plans for timeliness.
• Works with care management on member referrals.
• Performs other duties and adheres to policies.

Skills

Nursing assessment

Medical necessity evaluation

Discharge planning

Healthcare collaboration

Education

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Tools

Health management systems

Job description

Centene Corporation in Mississippi is seeking a Nurse Utilization Management professional to review inpatient admissions and concurrent care for medical necessity. The role supports the Magnolia Health Plan Utilization Management team and ensures appropriate care levels.

You will assess overall patient health, coordinate with medical leaders, and document outcomes in health systems, contributing to discharge planning and care optimization.