Clinical Review Nurse – Concurrent Review

Centene Corporation

. Perform concurrent reviews to determine members’ overall health, appropriate care, medical necessity, and level of care .

Posted 9/15/2026full-timeRemote • Missouri • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in concurrent reviews, medical necessity assessments, and care management processes, with a strong focus on compliance with Medicare and Medicaid regulations. Proven ability to collaborate with healthcare providers and document findings effectively in health management systems.

Highest-signal resume keywords

Active RN LicenseAcute Care Nursing ExperienceUtilization Management KnowledgeCase Management ExperienceClinical Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Concurrent ReviewDischarge PlanningMedical Necessity AssessmentCare ManagementUtilization Processes

Soft Skills

CollaborationLeadership FeedbackProvider Education

Tools & Technologies

Health Management SystemsMedical Records

Certifications & Qualifications

Compact RN License

Industry Keywords

Medicare RegulationsMedicaid RegulationsAcute CareCare TransitionsResource Consumption

About the role

Key responsibilities & impact

Perform concurrent reviews to determine members’ overall health, appropriate care, medical necessity, and level of care
Review acuity level, resource consumption, length of stay, and discharge planning
Work with Medical Affairs and/or Medical Directors regarding member care
Document concurrent review findings, discharge plans, and actions in medical records and health management systems
Work with healthcare providers on medical determinations and recommendations
Educate providers on utilization processes
Provide leadership feedback on appropriate level of care and medical necessity improvements
Review transfer and discharge plans to support timely transitions between care levels and facilities
Collaborate with care management on member referrals
Comply with policies and standards and perform other assigned duties

Requirements

What you’ll need

Active, unrestricted Compact RN License required
2+ years of acute care nursing experience required
Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing
2–4 years of related experience
Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred
Knowledge of Medicare and Medicaid regulations preferred
Knowledge of utilization management processes preferred
Previous UM, UR, Case Management, or Care Management experience preferred
Preference given to candidates who reside in Missouri

Benefits

Comp & perks

Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation