Clinical Review Nurse – Concurrent Review

Centene Corporation

. Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning .

Posted 10/9/2026full-timeRemote • Missouri • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in concurrent reviews, evaluating medical necessity, and discharge planning while collaborating with healthcare providers and leadership to enhance care quality. Proficient in utilization management processes and knowledgeable about Medicare and Medicaid regulations.

Highest-signal resume keywords

Concurrent ReviewUtilization ManagementAcute Care ExperienceClinical KnowledgeLicensed Practical Nurse

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Discharge PlanningMedical Necessity EvaluationCare Management CollaborationQuality of Care ReviewHealth Management Systems Documentation

Soft Skills

CommunicationCollaborationFeedback Provision

Certifications & Qualifications

Licensed Practical NurseRegistered NurseMO RN Licensure

Industry Keywords

Medicare RegulationsMedicaid RegulationsPost Acute CareUtilization Review

About the role

Key responsibilities & impact

Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning
Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member
Performs concurrent reviews of members for appropriate care and setting to determine overall health and appropriate level of care
Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning
Works with Medical Affairs and/or Medical Directors to discuss member care being delivered
Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems
Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings
Assists with providing education to providers on utilization processes
Provides feedback to leadership on opportunities to improve appropriate level of care and medical necessity
Reviews member transfer or discharge plans to ensure timely discharge between levels of care and facilities
Collaborates with care management on referral of members as appropriate
Performs other duties as assigned

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 - Licensed Practical Nurse - State Licensure required
RN - Registered Nurse - State Licensure and/or Compact State Licensure
MO RN Licensure highly preferred
Post acute care experience and/or utilization review experience highly preferred
Complies with all policies and standards

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