Remote Utilization Review Nurse – RN/LPN (Case Management)

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

Job summary

Centene Management Company LLC is seeking a licensed Practical Nurse (LPN) or Registered Nurse (RN) for remote case management in Pennsylvania. The role focuses on concurrent reviews to verify appropriate care levels and medical necessity, with collaboration across Medical Affairs and physicians.

Requires active PA or Compact State licensure and 2+ years in acute care. Prior experience with utilization management and familiarity with MCG/InterQual criteria are a plus.

Qualifications

• Must be a licensed RN or LPN with active state licensure.
• 2+ years of acute care experience preferred.
• Knowledge of Medicare/Medicaid regulations and utilization processes is a plus.

Responsibilities

• Perform concurrent reviews to assess care level and medical necessity.
• Collaborate with Medical Affairs/Medical Directors on member care.
• Document findings, discharge plans, and actions in health systems.
• Educate providers on utilization processes to ensure quality care.
• Support timely discharge and coordinate transfers between care settings.

Skills

Case management

Utilization management (UM)

Utilization review (UR)

MCG criteria

InterQual criteria

Education

Bachelor's degree in Nursing

Graduate from an Accredited School of Nursing

Job description

Centene Management Company LLC is seeking a licensed Practical Nurse (LPN) or Registered Nurse (RN) for remote case management in Pennsylvania. The role focuses on concurrent reviews to verify appropriate care levels and medical necessity, with collaboration across Medical Affairs and physicians.

Requires active PA or Compact State licensure and 2+ years in acute care. Prior experience with utilization management and familiarity with MCG/InterQual criteria are a plus.