Remote Utilization Review Nurse (RN) – Post-Acute Care

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

Benefits offered by this job

Remote work

Health insurance

401K plan

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Management Company LLC is seeking a remote Nurse Reviewer to perform concurrent reviews, determine the member’s health status, and oversee appropriate levels of care across Medicaid and Market Place plans. You will collaborate with Medical Affairs and discharge planning teams while educating providers on utilization processes.

The ideal candidate holds a nursing degree with 5+ years of nursing experience, including acute care, and preferably compact licensure.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing.
• 2–4 years of related experience in nursing.
• 2+ years of acute care experience required.
• Knowledge of Medicare and Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.

Responsibilities

• Perform concurrent reviews to assess overall member health and appropriate level of care.
• Review acuity, resource use, length of stay, and discharge planning.
• Collaborate with Medical Affairs/Directors to discuss member care.
• Educate providers on utilization processes to ensure quality care.
• Document findings and maintain discharge plans in health management systems.
• Assist with coordinating transfer or discharge across facilities.

Skills

Clinical assessment

Discharge planning

Utilization management

Education

Bachelor’s degree in Nursing

Job description

Centene Management Company LLC is seeking a remote Nurse Reviewer to perform concurrent reviews, determine the member’s health status, and oversee appropriate levels of care across Medicaid and Market Place plans. You will collaborate with Medical Affairs and discharge planning teams while educating providers on utilization processes.

The ideal candidate holds a nursing degree with 5+ years of nursing experience, including acute care, and preferably compact licensure.