Clinical Review Nurse – Concurrent Review

Centene Corporation

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

Posted 9/30/2026full-timeRemote • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical evaluation and care management, with a strong focus on utilization management processes and compliance with Medicare and Medicaid regulations. Capable of collaborating effectively with healthcare providers to ensure appropriate care and improve overall health outcomes for members.

Highest-signal resume keywords

RN State LicensureLPN State LicensureAcute Care ExperienceUtilization Management ProcessesClinical Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Concurrent ReviewsDischarge PlanningMedical Necessity EvaluationCare Setting ValidationHealth Management Systems Documentation

Soft Skills

CollaborationLeadership FeedbackProvider Education

Industry Keywords

Medicare RegulationsMedicaid RegulationsHealthcare Provider CollaborationCare ManagementMember Referrals

About the role

Key responsibilities & impact

Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care
Review acuity, resource consumption, length of stay, quality and continuity of care, and discharge planning
Evaluate inpatient services to validate medical necessity and care setting
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 level of care and medical necessity
Review transfer and discharge plans to support timely transitions between care levels and facilities
Collaborate with care management on member referrals
Perform other assigned duties and comply with policies and standards

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
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
LPN state licensure required
RN state licensure and/or Compact State Licensure for State of Nevada required
RN compact nursing licensure preferred or ability to achieve licensures in other states as needed
Ability to work Monday–Friday, 8am–5pm based on resident time zone, with rotational weekends and holidays

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
Cost of obtaining licensures in other states reimbursed by the company