- Business Area: Clinical & Care Management
- Job Type: Full time
- Date Posted: Jun 09 2026
- Job Number: 1638740
This job is available in 7 locations
- Remote-AR
- Remote-FL
- Remote-GA
- Remote-KS
- Remote-KY
- Remote-MO
- Remote-TN
Keywords
Clinical Review Nurse - Concurrent Review
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Description
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
- Applicants for this role must have a compact nursing license and will have the flexibility to work remotely from their home anywhere in the Eastern or Central time zone. The work schedule will be Monday – Friday, 8am – 5pm, Central with a rotating weekend / holiday schedule as needed. An RN with previous Post Acute experience is strongly preferred.**
Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.
- Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care
- Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member
- Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered
- Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines
- Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings
- Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members
- Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines
- Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities
- Collaborates with care management on referral of members as appropriate
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 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.
License/Certification
- LPN - Licensed Practical Nurse - State Licensure required
Pay Range: $27.02 - $48.55 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Clinical and Care Management Jobs
Jobs in Arkansas
Centene first established operations in Arkansas in 1996. Through Arkansas Total Care, Centene provides quality-focused, affordable healthcare delivered locally.
Jobs in Florida
Centene first established operations in Florida in 1985. Through Sunshine Health, Centene provides quality-focused, affordable healthcare delivered locally.
Jobs in Georgia
Centene first established operations in Georgia in 2005. Through Peach State Health Plan, Centene provides quality-focused, affordable healthcare delivered locally.
Jobs in Kansas
Centene first established operations in Kansas in 2006. Through Sunflower Health Plan, Centene provides quality-focused, affordable healthcare delivered locally.
Jobs in Kentucky
Centene first established operations in Kentucky in 2006. Through WellCare of Kentucky, Centene provides quality-focused, affordable healthcare delivered locally.
Jobs in Missouri
Through Home State Health Plan, Centene provides quality-focused, affordable healthcare delivered locally. Also, Missouri is home to Centene's Corporate Headquarters.
Jobs in Tennessee
Centene established operations in Tennessee in 2006. There are many remote roles available here to help Centene provide quality-focused, affordable healthcare delivered locally.
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