Clinical Review Nurse – Concurrent Review

🔥 12 hours ago

🌽 Illinois – Remote

🌽 Illinois – 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

• Perform concurrent reviews, including determining members’ overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning • Evaluate inpatient services to validate the necessity and setting of care delivered to members • Support Utilization Management/Concurrent Review for the YouthCare program • Support inpatient-only reviews and cross-train for Prior Authorization • Determine appropriate care and setting based on members’ overall health and appropriate level of care • Review quality and continuity of care, including 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 • 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 • Comply with all policies and standards • Perform other duties as assigned

🎯 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 • 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 • Must hold IL RN licensure • RN - Registered Nurse - State Licensure for IL YouthCare • Ability to work Monday–Friday, 8am–5pm Central Time during training/scheduled hours

🏖️ Benefits

• 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 • Additional forms of incentives may be included in total compensation