Remote Utilization Review RN – Discharge & Care Coordination

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

Benefits offered by this job

Health insurance

401K plans

Stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible remote/hybrid/work schedules

Job summary

Centene Management Company LLC is seeking a remote Nurse Reviewer to support Marketplace/Ambetter members across multiple states. The role involves concurrent reviews, determining appropriate level of care, discharge planning, and collaboration with Medical Affairs to ensure quality, cost-effective care.

Ideal candidates hold RN or LPN licensure, have acute care experience (acute rehab/SNF/LTC), and are eligible for licensure in required states.

Qualifications

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

Responsibilities

• Perform concurrent reviews to determine appropriate care level and setting.
• Collaborate with Medical Affairs/Medical Directors on member care decisions.
• Document and maintain concurrent review findings, discharge plans, and actions taken.
• Educate providers on utilization processes to ensure high-quality, appropriate care.

Skills

Nursing licensure

Acute care experience

Inpatient discharge planning

Utilization management

Remote-work readiness

Education

Bachelor’s degree in Nursing

Graduate from Accredited School of Nursing

Job description

Centene Management Company LLC is seeking a remote Nurse Reviewer to support Marketplace/Ambetter members across multiple states. The role involves concurrent reviews, determining appropriate level of care, discharge planning, and collaboration with Medical Affairs to ensure quality, cost-effective care.

Ideal candidates hold RN or LPN licensure, have acute care experience (acute rehab/SNF/LTC), and are eligible for licensure in required states.