Clinical Review Nurse – Concurrent Review

Centene Corporation

. Perform concurrent reviews, including determining members’ overall health, reviewing care delivered, evaluating medical necessity, and contributing to discharge planning .

Posted 10/5/2026full-timeRemote • North Carolina • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in concurrent reviews, medical necessity evaluations, and discharge planning within healthcare settings. Possesses strong clinical knowledge and familiarity with Medicare and Medicaid regulations, ensuring compliance and effective care management.

Highest-signal resume keywords

Acute Care ExperienceLPN State LicensureRN LicenseUtilization Management ProcessesClinical Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Concurrent ReviewMedical Necessity EvaluationDischarge PlanningCare ManagementHealth Management Systems DocumentationAcuity Level ReviewResource Consumption AnalysisLength of Stay EvaluationMember Care CollaborationProvider Education

Soft Skills

Leadership FeedbackCollaboration

Certifications & Qualifications

RN State LicensureLPN State Licensure

Industry Keywords

Medicare RegulationsMedicaid RegulationsUtilization ManagementHealthcare ProvidersMember Referrals

About the role

Key responsibilities & impact

Perform concurrent reviews, including determining members’ overall health, reviewing care delivered, evaluating medical necessity, and contributing to discharge planning
Evaluate inpatient services to validate the necessity and setting of care
Review acuity level, resource consumption, length of stay, 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 or discharge plans to ensure timely transitions between levels of care and facilities
Collaborate with care management on member referrals
Comply with all policies and standards; 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
LPN state licensure required
For Health Net of California: RN license required
For State of Nevada: RN state licensure and/or Compact State Licensure required
Clinical knowledge and ability 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

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