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Clinical Review Nurse – Concurrent Review
Centene Corporation. Performs concurrent reviews to determine members’ overall health, appropriate care, and level of care .
Posted 9/15/2026full-timeRemote • North Carolina • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in concurrent reviews, utilization management, and case management, with a strong focus on member health assessment and care coordination. Proficient in collaborating with healthcare providers and leadership to enhance care quality and compliance with regulations.
Highest-signal resume keywords
Acute Care Nursing ExperienceUtilization Management (UM)Case Management (CM)Medicare and Medicaid KnowledgeLicensed Practical Nurse (LPN) or Registered Nurse (RN) Licensure
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Concurrent ReviewCare CoordinationDischarge PlanningClinical AssessmentUtilization Processes
Soft Skills
CollaborationLeadership FeedbackProvider Education
Tools & Technologies
Health Management Systems
Certifications & Qualifications
Licensed Practical Nurse (LPN)Registered Nurse (RN) State LicensureCompact State Licensure
Industry Keywords
Quality of CareAcuity LevelResource ConsumptionLength of StayMedical Necessity
About the role
Key responsibilities & impact- Performs concurrent reviews to determine members’ overall health, appropriate care, and level of care
- Reviews quality and continuity of care, including acuity level, resource consumption, length of stay, and discharge planning
- Works with Medical Affairs and/or Medical Directors to discuss member care
- Collects, documents, and maintains concurrent review findings, discharge plans, and actions in health management systems
- Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and review findings
- Educates providers on utilization processes to support high-quality, appropriate care
- Provides leadership feedback on opportunities to improve level of care and medical necessity
- Reviews transfer and discharge plans to support timely transitions between care levels and facilities
- Collaborates with care management on member referrals
- Performs other assigned duties
Requirements
What you’ll need- Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing
- Minimum 2 years of acute care nursing experience required
- 2–4 years of related experience
- LPN - Licensed Practical Nurse - State Licensure required
- RN - Registered Nurse - State Licensure and/or Compact State Licensure
- 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
- Previous Utilization Management (UM) and/or Case Management (CM) experience preferred
- Must comply with all policies and standards
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K plan
- 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