Clinical Review Nurse – Concurrent Review

🔥 14 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – 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.

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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

• Performs concurrent reviews to determine members’ overall health, appropriate care, and level of care • Reviews quality and continuity of care, including acuity level, resource consumption, length of stay, and discharge planning • Works with Medical Affairs and/or Medical Directors to discuss member care • Collects, documents, and maintains concurrent review findings, discharge plans, and actions in health management systems • Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and review findings • Educates providers on utilization processes to support high-quality, appropriate care • Provides leadership feedback on opportunities to improve level of care and medical necessity • Reviews transfer and discharge plans to support timely transitions between care levels and facilities • Collaborates with care management on member referrals • Performs other assigned duties

🎯 Requirements

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing • Minimum 2 years of acute care nursing experience required • 2–4 years of related experience • LPN - Licensed Practical Nurse - State Licensure required • RN - Registered Nurse - State Licensure and/or Compact State Licensure • 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 • Previous Utilization Management (UM) and/or Case Management (CM) experience preferred • Must comply with all policies and standards

🏖️ 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 • Equal opportunity employer committed to diversity