Clinical Review Nurse – Concurrent Review

Centene Corporation

. Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care .

Posted 9/22/2026full-timeRemote • North Carolina • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in concurrent reviews, discharge planning, and utilization management processes while ensuring compliance with Medicare and Medicaid regulations. Possesses strong clinical knowledge to assess overall health and appropriate levels of care.

Highest-signal resume keywords

Concurrent ReviewDischarge PlanningUtilization ManagementAcute Care ExperienceLicensed Practical Nurse (LPN)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical KnowledgeHealth Management SystemsMedical DeterminationsCare Management CollaborationAcuity Level Review

Soft Skills

Leadership FeedbackProvider EducationCollaboration

Certifications & Qualifications

LPN State Licensure

Industry Keywords

Medicare RegulationsMedicaid RegulationsLevel of CareResource ConsumptionLength of Stay

About the role

Key responsibilities & impact

Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care
Review acuity level, resource consumption, length of stay, and discharge planning
Work with Medical Affairs and/or Medical Directors regarding 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 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 duties as assigned

Requirements

What you’ll need

Must reside in North Carolina
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, 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

Benefits

Comp & perks

Competitive pay
Health insurance
401K and 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