Clinical Review Nurse – Concurrent Review

Centene Corporation

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

Posted 9/21/2026full-timeRemote • California • 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 clinical assessment, utilization management, and care coordination, with a strong focus on compliance with Medicare and Medicaid regulations. Proven ability to collaborate with healthcare providers and document care plans effectively.

Highest-signal resume keywords

Active RN License In CaliforniaAcute Care ExperienceClinical KnowledgeUtilization Management ProcessesHealthcare Provider Collaboration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Concurrent ReviewDischarge PlanningMedical Necessity DeterminationQuality Of Care AssessmentResource Consumption Analysis

Soft Skills

Leadership FeedbackProvider EducationCollaboration

Tools & Technologies

Health Management Systems

Certifications & Qualifications

RN License

Industry Keywords

Medicare RegulationsMedicaid RegulationsUtilization ManagementCare Management

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, quality and continuity of care, and discharge planning
Work with Medical Affairs and Medical Directors regarding member care
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 appropriate level of care and medical necessity
Review transfer and discharge plans for timely transitions between levels of care and facilities
Collaborate with care management on member referrals
Comply with policies and standards and perform other assigned duties

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
Active RN license in California required
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
Required schedule: Monday–Friday, 8:00 am–5:00 pm Pacific Standard Time (PST)
Regular weekend and holiday rotation required

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
Competitive pay
Additional forms of incentives may be included in total compensation