Clinical Review Nurse – Concurrent Review

🔥 11 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Complete timely inpatient utilization reviews against medical necessity criteria, health plan policies, and applicable standards • Review clinical records and document decisions accurately • Refer appropriate cases for medical director review • Work with providers, facilities, and internal teams to coordinate care and support discharge planning • Assist with quality reviews, audits, and compliance activities • Manage daily case volume while meeting quality, turnaround time, and productivity expectations • Share clinical expertise with teammates and raise recurring issues or improvement opportunities to leadership • Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care • Review acuity level, resource consumption, length of stay, quality, continuity of care, 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 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 or discharge plans to ensure timely discharge between levels of care and facilities • Collaborate with care management on member referrals • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• 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 • LPN - Licensed Practical Nurse - State Licensure 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 • Ability to comply with all policies and standards

🏖️ Benefits

• 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 employment • Consideration for qualified applicants with arrest or conviction records in accordance with applicable law