Clinical Review Nurse – Concurrent Review

Centene Corporation

. Review inpatient admissions and elective procedures to determine medical necessity .

Posted 9/21/2026full-timeRemote • Mississippi • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical necessity reviews, concurrent reviews, and care management processes. Possesses strong clinical knowledge and the ability to collaborate effectively with healthcare providers and leadership to enhance patient care and compliance with regulations.

Highest-signal resume keywords

Licensed Practical Nurse (LPN)Registered Nurse (RN)Acute Care ExperienceUtilization Management ProcessesMedicare and Medicaid Regulations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Necessity ReviewConcurrent ReviewDischarge PlanningCare ManagementClinical Knowledge

Soft Skills

CollaborationLeadership FeedbackProvider Education

Tools & Technologies

Health Management Systems

Certifications & Qualifications

State Licensure (LPN)State Licensure (RN)Compact State Licensure (RN)

Industry Keywords

Inpatient AdmissionsElective ProceduresLevel of CareQuality of CareContinuity of Care

About the role

Key responsibilities & impact

Review inpatient admissions and elective procedures to determine medical necessity
Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care
Review acuity level, resource consumption, length of stay, quality, continuity of care, and discharge planning
Work with Medical Affairs and/or Medical Directors to discuss member care
Collect, document, and maintain concurrent 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 for timely transitions between levels of care 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

Candidates must reside in Mississippi
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 - Licensed Practical Nurse - State Licensure required
For Health Net of California: RN license required
RN - Registered Nurse - State Licensure and/or Compact State Licensure for State of Nevada 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
Standard schedule is Monday through Friday

Benefits

Comp & perks

Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off
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