Remote Utilization Review RN

Centene; United States; Remote; USD 37,000 - 67,000; Full time

Benefits offered by this job

Remote work

Health insurance

401K and stock purchase plans

Job summary

Centene Corporation seeks a remote RN for concurrent reviews to determine appropriate care levels and discharge plans. The role supports Ambetter members in Georgia with hours 8am–5pm ET, Mon–Fri, and requires active RN licensure via a state board or compact license.

Prior acute care experience and familiarity with utilization management are preferred. Responsibilities include documenting findings, coordinating with care teams, and educating providers on utilization processes, while ensuring

Qualifications

• Requires nursing degree (RN/BSN) and 2–4 years of related experience.
• RN license and state licensure; compact state licensure for Nevada may be required.
• Knowledge of Medicare/Medicaid regulations and utilization management processes preferred.

Responsibilities

• Perform concurrent reviews to determine appropriate care level and setting.
• Review acuity, resource use, length of stay, and discharge plans.
• Collaborate with Medical Affairs/Medical Directors on care decisions.

Skills

Nursing

Utilization management

Acute care

Education

Nursing degree (RN/BSN)

Bachelor's degree in Nursing

Tools

Health management systems

Job description

Centene Corporation seeks a remote RN for concurrent reviews to determine appropriate care levels and discharge plans. The role supports Ambetter members in Georgia with hours 8am–5pm ET, Mon–Fri, and requires active RN licensure via a state board or compact license.

Prior acute care experience and familiarity with utilization management are preferred. Responsibilities include documenting findings, coordinating with care teams, and educating providers on utilization processes, while ensuring