Clinical Review Nurse – Concurrent Review, NICU

Centene Corporation

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

Posted 10/6/2026full-timeRemote • Illinois • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in concurrent reviews, care management, and utilization management processes, with a strong focus on member health assessment and discharge planning. Holds necessary nursing licensures and possesses extensive NICU and acute care experience.

Highest-signal resume keywords

RN State LicensureLPN State Licensure3+ Years NICU ExperienceUtilization Management KnowledgeMedicare and Medicaid Regulations Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Concurrent ReviewCare ManagementDischarge PlanningClinical AssessmentResource Consumption AnalysisAcuity Level ReviewMedical Necessity DeterminationDocumentation in Health Management SystemsQuality of Care ReviewMember Health Evaluation

Soft Skills

CollaborationLeadership FeedbackProvider EducationCommunication

Certifications & Qualifications

NICU Certification

Industry Keywords

MedicaidAmbetterAcute CareHealthcare ProvidersUtilization Processes

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
Work with Medical Affairs and/or Medical Directors to discuss member care
Collect, document, and maintain concurrent review findings, discharge plans, and actions taken in member medical records and health management systems
Work with healthcare providers to approve medical determinations or provide recommendations based on requested services and review findings
Educate providers on utilization processes
Provide leadership feedback on opportunities to improve appropriate level of care and medical necessity
Review member transfer or discharge plans to ensure timely discharge between levels of care and facilities
Collaborate with care management on member referrals
Support Medicaid and Ambetter/marketplace insurance members
Comply with all policies and standards
Perform other duties as assigned

Requirements

What you’ll need

Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing
3+ years of level III or IV NICU experience
2+ years of acute care experience
LPN state licensure required
RN state licensure and/or compact state licensure for State of Nevada required
Ability to achieve licensures in non-compact states
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
NICU certification helpful
Prefer applicants residing in either central or eastern time zones

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
Cost reimbursement for achieving licensure in non-compact states