Remote Utilization Review Nurse - Post-Acute Care

Centene Corporation; Washington; 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 + holidays

Flexible work arrangement

Job summary

Centene Corporation is hiring a nurse reviewer to perform concurrent reviews for Medicaid and Marketplace post-acute care from a fully remote role. Ideal candidates reside in Central, Mountain, or Pacific Time Zones and hold compact licensure with 5+ years of nursing experience, including LTACH/IPR/SNF settings.

Typical schedule is Mon–Fri, 8am–5pm based on your time zone with rotating Saturdays and holidays. Eligible for competitive pay and benefits.

Qualifications

• Nursing degree or equivalent and active licensure in nursing.
• 2–4 years of related nursing experience with 2+ years acute care experience.
• Knowledge of Medicare/Medicaid regulations and utilization management preferred.

Responsibilities

• Perform concurrent reviews to determine appropriate level of care.
• Review acuity, resource use, length of stay, and discharge planning.
• Collaborate with Medical Affairs/Medical Directors as needed.
• Document findings and discharge plans in health management systems.
• Assist providers with utilization processes and educate on requirements.
• Provide feedback to leadership on care improvements.
• Review transfer/discharge plans to ensure timely transitions.
• Collaborate on referrals as appropriate.
• Perform other duties as assigned.
• Comply with all policies and standards.

Education

Graduate from Accredited School of Nursing or Bachelor’s degree in Nursing

LPN - Licensed Practical Nurse State Licensure

RN - Registered Nurse State Licensure/Compact State Licensure

Job description

Centene Corporation is hiring a nurse reviewer to perform concurrent reviews for Medicaid and Marketplace post-acute care from a fully remote role. Ideal candidates reside in Central, Mountain, or Pacific Time Zones and hold compact licensure with 5+ years of nursing experience, including LTACH/IPR/SNF settings.

Typical schedule is Mon–Fri, 8am–5pm based on your time zone with rotating Saturdays and holidays. Eligible for competitive pay and benefits.