Clinical Review Nurse – Concurrent Review

Centene Corporation

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

Posted 10/2/2026full-timeRemote • 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 member health and collaborate effectively with healthcare providers.

Highest-signal resume keywords

Acute Care ExperienceUtilization Management ProcessesMedicare RegulationsMedicaid RegulationsLPN State Licensure

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Concurrent ReviewDischarge PlanningClinical KnowledgeHealth Management Systems DocumentationMember Health Assessment

Soft Skills

CollaborationLeadership FeedbackProvider Education

Certifications & Qualifications

RN State LicensureCompact RN Nursing Licensure

Industry Keywords

Healthcare ProvidersCare ManagementResource ConsumptionQuality of CareContinuity of Care

About the role

Key responsibilities & impact

Perform concurrent reviews to determine members’ overall health, appropriate care, setting, and level of care
Review acuity, resource consumption, length of stay, quality, continuity of care, and discharge planning
Work with Medical Affairs and/or Medical Directors regarding member care
Document 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 level-of-care and medical-necessity improvements
Review transfer and discharge plans to support timely transitions
Collaborate with care management on member referrals
Comply with 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
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 state licensure required
RN state licensure and/or Compact State Licensure; Nevada requires state licensure
Compact RN nursing licensure preferred
Monday–Friday availability, 8am–5pm Eastern Time

Benefits

Comp & perks

Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off
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