Remote Utilization Review Nurse (Med/Surg ICU/Peds)

Centene Management Company LLC; Iowa (LA); Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Remote work flexibility

Job summary

Centene Management Company LLC is seeking a Nurse Reviewer to perform concurrent reviews, validate medical necessity, and contribute to discharge planning. Remote work from home is allowed, requiring Iowa or compact licensure and 2+ years acute care experience.

The role collaborates with Medical Affairs and providers to ensure appropriate care, while maintaining documentation of findings and discharge plans in health systems. LPN licensure is required.

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 appropriate level of care.
• Knowledge of Medicare and Medicaid regulations preferred.
• LPN license required (State licensure).

Responsibilities

• Perform concurrent reviews to determine appropriate care and setting.
• Review acuity level, resource use, length of stay, and discharge planning.
• Collaborate with Medical Affairs/Medical Directors on care determinations.
• Educate providers on utilization processes to ensure quality care.
• Document review findings and discharge plans in health systems.
• Assist with timely transfers or discharges between levels of care.
• Support leadership with opportunities to improve care and medical necessity.

Skills

Utilization management

Acute care

Clinical knowledge

Nursing license

Education

Bachelor's degree in Nursing

Graduate from an Accredited School of Nursing

Job description

Centene Management Company LLC is seeking a Nurse Reviewer to perform concurrent reviews, validate medical necessity, and contribute to discharge planning. Remote work from home is allowed, requiring Iowa or compact licensure and 2+ years acute care experience.

The role collaborates with Medical Affairs and providers to ensure appropriate care, while maintaining documentation of findings and discharge plans in health systems. LPN licensure is required.