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 • Florida • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in evaluating member health and care needs, ensuring compliance with Medicare and Medicaid regulations, and effectively collaborating with healthcare providers for optimal care management. Proficient in documentation and utilization management processes to support quality care transitions.

Highest-signal resume keywords

Active Nursing LicensureAcute Care ExperienceUtilization Management KnowledgeClinical Evaluation SkillsHealthcare Provider Collaboration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Health Management Systems DocumentationCare Level EvaluationDischarge PlanningMedical Necessity ValidationQuality of Care Review

Soft Skills

Leadership FeedbackProvider EducationCollaboration

Certifications & Qualifications

LPN State LicensureRN State LicensureCompact State Licensure

Industry Keywords

Medicare RegulationsMedicaid RegulationsUtilization ProcessesMember ReferralsCare Management

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
Evaluate inpatient services to validate medical necessity and care setting
Work with Medical Affairs and/or Medical Directors regarding member care
Document and maintain review findings, discharge plans, and actions in health management systems
Work with healthcare providers on medical determinations and service recommendations
Educate providers on utilization processes
Provide leadership feedback on appropriate 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 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 compact/multi-state nursing licensure in good standing
LPN state licensure required
RN state licensure and/or compact state licensure required for the State of Nevada
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
Ability to work Monday–Friday, 8am–5pm based on residence time zone
Ability to work 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