Clinical Review Nurse – Concurrent Review

Centene Corporation

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

Posted 10/8/2026full-timeRemote • Michigan • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in concurrent reviews, care management, and utilization management processes, with a strong focus on quality and continuity of care. Holds necessary nursing licensure and possesses clinical knowledge to assess treatment needs and appropriate care levels.

Highest-signal resume keywords

RN State LicensureAcute Care ExperienceUtilization Management ProcessesClinical KnowledgeMedicare and Medicaid Regulations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Concurrent ReviewsCare ManagementDischarge PlanningQuality of Care AssessmentResource Consumption AnalysisMedical DeterminationsDocumentation in Health Management SystemsAcuity Level EvaluationLeadership FeedbackCollaboration with Healthcare Providers

Soft Skills

Education of ProvidersCommunicationCollaboration

Certifications & Qualifications

LPN State LicensureUnencumbered Compact Nursing LicenseMichigan Nursing Licensure

Industry Keywords

HealthcareAcute CareMedicareMedicaidUtilization ManagementCare LevelsDischarge PlansHealth Management Systems

About the role

Key responsibilities & impact

Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care
Review quality and continuity of care, acuity level, resource consumption, length of stay, and discharge planning
Work with Medical Affairs and/or Medical Directors regarding member care
Collect, document, and maintain review findings, discharge plans, and actions in health management systems
Work with healthcare providers to approve medical determinations or provide recommendations
Educate providers on utilization processes
Provide leadership feedback on opportunities to improve care levels and medical necessity
Review transfer and discharge plans for timely transitions between care levels and facilities
Collaborate with care management on member referrals
Comply with all policies and standards
Perform other duties as assigned

Requirements

What you’ll need

Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing
2–4 years of related experience
2+ years of acute care experience required
LPN state licensure required
RN state licensure and/or compact state licensure for the state of Nevada required
Hospital experience, ED or acute care preferred
Unencumbered compact nursing license and Michigan nursing licensure preferred
Clinical knowledge to determine overall health, treatment needs, and appropriate level of care preferred
Knowledge of Medicare and Medicaid regulations preferred
Knowledge of utilization management processes preferred
Prefer applicants residing in Central or Eastern Time Zones
Availability Monday–Friday, 8am–5pm in resident time zone, with rotational weekends and holidays

Benefits

Comp & perks

Competitive pay
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
Equal opportunity employer committed to diversity