# Clinical Review Nurse – Concurrent Review Remote from[USA](https://jobicy.com/job-region/usa.md)Salary, yearly, USD 54,000 - 98,000Department [Healthcare & Medical](https://jobicy.com/categories/healthcare.md) Employment type Full Time, Job posted20 Jul 2026Apply before20 Aug 2026Experience level Midweight Views / Applies 151 / 3 [About company](https://jobicy.com/company/centene-corporation.md) * Share About [Centene Corporation](https://jobicy.com/company/centene-corporation.md) Transforming the health of the community, one person at a time. [Hospital & Health Care](https://jobicy.com/company-category/hospital-health-care.md) * 1984 Verified job posting This job post has been [manually reviewed](https://jobicy.com/tools/help-center/employee/how-does-jobicy-verify-the-legitimacy-of-remote-job-listings.md) for authenticity and compliance. ### AI Summary This role involves performing concurrent reviews of member care to determine medical necessity, appropriate level of care, and discharge planning. The Clinical Review Nurse collaborates with healthcare providers and medical directors to ensure high-quality, cost-effective care. Requires an RN or LPN license and 2-4 years of experience, including 2+ years in acute care. Knowledge of Medicare/Medicaid and utilization management is preferred. The position is remote with on-call weekend and holiday rotations. ### Role DNA Job Complexity Easy Hard Pace & Pressure Relaxed Fast-paced Autonomy Level Guided Full Ownership Communication Load Independent Highly Collaborative AI Insight The role requires clinical judgment and knowledge of utilization management, but follows established guidelines and receives support from medical directors, making it moderately difficult. ### Salary Analysis Median Highly Competitive USD76,000US Market USD54k – 98k 0 USD108k AI Insight The offered salary range of $54,000 to $98,000 annually is competitive for a Clinical Review Nurse position, aligning with the national average for similar roles. The median of $76,000 reflects the experience and licensure required. ### Core Skills Required [Utilization Review](https://jobicy.com/jobs?search_keywords=Utilization+Review.md) [Concurrent Review](https://jobicy.com/jobs?search_keywords=Concurrent+Review.md) [Clinical Nursing](https://jobicy.com/jobs?search_keywords=Clinical+Nursing.md) [Medicare](https://jobicy.com/jobs?search_keywords=Medicare.md) [Medicaid](https://jobicy.com/jobs?search_keywords=Medicaid.md) [Care Coordination](https://jobicy.com/jobs?search_keywords=Care+Coordination.md) [Discharge Planning](https://jobicy.com/jobs?search_keywords=Discharge+Planning.md) [Medical Necessity](https://jobicy.com/jobs?search_keywords=Medical+Necessity.md) [Acute Care](https://jobicy.com/jobs?search_keywords=Acute+Care.md) [Registered Nurse](https://jobicy.com/jobs?search_keywords=Registered+Nurse.md) ### Cover Letter Sample Dear Hiring Manager, I am writing to express my interest in the Clinical Review Nurse - Concurrent Review position at Centene. With a BSN and over 3 years of acute care experience, I have developed strong clinical assessment skills and a deep understanding of medical necessity and discharge planning. In my previous role, I conducted concurrent reviews, collaborated with interdisciplinary teams, and ensured compliance with utilization management policies. My knowledge of Medicare and Medicaid regulations will allow me to contribute effectively to your team. I am excited about the opportunity to work remotely and support Centene's mission of providing high-quality, appropriate care to members. Thank you for considering my application. Sincerely, [Your Name] Copy ### Sample Interview Questions Describe your experience with concurrent review and how you determine medical necessity.In my previous role, I reviewed inpatient cases daily, using InterQual and MCG criteria to assess the appropriateness of the level of care. I worked closely with physicians to clarify clinical details and ensured documentation supported continued stay or discharge.How do you handle conflicts when a provider disagrees with your utilization review decision?I would first listen to the provider's perspective and review the clinical evidence. If necessary, I would escalate to the Medical Director for a peer-to-peer discussion, maintaining a collaborative approach to ensure the best outcome for the member.Can you explain the importance of discharge planning in concurrent review?Discharge planning is crucial to ensure timely and safe transitions, reduce readmissions, and optimize resource use. I coordinate with case managers, social workers, and families to arrange post-acute services and communicate plans with the care team.What experience do you have with Medicare and Medicaid regulations?I have worked with Medicare Advantage and Medicaid managed care plans, understanding coverage guidelines and regulatory requirements. I have applied CMS criteria and state-specific policies in my reviews to ensure compliance.How do you prioritize your workload when handling multiple concurrent reviews?I assess urgency based on clinical complexity and length of stay, focusing on critical cases first. I use time management tools and communicate with the team to ensure all reviews are completed within required timelines, especially during on-call rotations. 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. This is a remote role. This position has on call weekend and holiday rotations 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 Preferred Qualifications RN-Registered Nurse-State Licensure and/or Compact State Licensure 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 Show more [Apply now >](https://jobicy.com/jobs/149475-clinical-review-nurse-concurrent-review.md) * ![Upload CV](data:image/svg+xml;base64,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) ### Upload your resume now To unlock remote work opportunities and be discovered by global employers. This job listing has been manually reviewed by the Jobicy Trust & Safety Team for compliance with our posting guidelines, including verification of the company's legitimacy, accuracy of job details, clarity of remote work policy, and absence of misleading or fraudulent content. ## How to apply ## See a few more Similar Healthcare & Medical remote jobs * ![National Veterinary Associates logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/10359f4b-221.png) National Veterinary Associates ### [Veterinary Assistant](https://jobicy.com/jobs/144248-veterinary-assistant.md) Job DescriptionHometown Animal Hospital/All Pets Dental Clinic is looking to fill an opening for a Veterinary Assistant with potential for growth!Hometown Animal Hospital/All Pets Dental Clinic is an NVA owned… ![USA flag](https://cloud.jobicy.com/nyc4-cold/img/round-flags/us.svg) US•Full TimeNEW* ![Philips logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2021/11/c1f456ee3fc507d644eb50420511ad91.jpg) Philips ### [Clinical Consultant – Radiology Informatics (RIS)](https://jobicy.com/jobs/144974-clinical-consultant-radiology-informatics-ris.md) Job TitleClinical Consultant – Radiology Informatics (RIS)Job DescriptionAs a clinical consultant in our Radiology Informatics organization, you will be responsible for coordinating and implementing activities required to provide application configuration,… ![UK flag](https://cloud.jobicy.com/nyc4-cold/img/round-flags/gb.svg) GB•Full TimeJul 19* ![Dandy logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/2321b7db-221-1.jpeg) Dandy ### [CX Lab Tech – Removables (UK)](https://jobicy.com/jobs/144109-cx-lab-tech-removables-uk.md) Dandy is transforming the massive and antiquated dental industry—an industry worth over $400B. Backed by some of the world’s leading venture capital firms, we’re on an ambitious mission to simplify… ![UK flag](https://cloud.jobicy.com/nyc4-cold/img/round-flags/gb.svg) GB•Full TimeJul 19* ![Arine logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/1692a4fa-221.png) Arine ### [Clinical Program Pharmacist](https://jobicy.com/jobs/147005-clinical-program-pharmacist.md) Based in San Francisco, Arine is a rapidly growing healthcare technology and clinical services company with a mission to ensure individuals receive the safest and most effective treatments for their unique… ![USA flag](https://cloud.jobicy.com/nyc4-cold/img/round-flags/us.svg) US•Full TimeUSD 135k-140k/year* ![Dexterra Group logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/bbc27733-221.png) Dexterra Group ### [Relief Chef](https://jobicy.com/jobs/147003-relief-chef.md) Company DescriptionWHO ARE WE? We’ve been serving Canadian clients for over 75 years. The companies that began independently and now form Dexterra Group have an outstanding record of supporting the… ![Canada flag](https://cloud.jobicy.com/nyc4-cold/img/round-flags/ca.svg) CA•Full TimeJul 18* ![SGS logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/03a5b446-221.jpeg) SGS ### [Global Quality and Laboratory Improvement Manager](https://jobicy.com/jobs/146086-global-quality-and-laboratory-improvement-manager.md) Company DescriptionWe are SGS – the world’s leading testing, inspection and certification company. We are recognized as the global benchmark for quality and integrity. Our 98,000 employees operate a network… ![Canada flag](https://cloud.jobicy.com/nyc4-cold/img/round-flags/ca.svg) CA•Full TimeJul 14* ![Datavant logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/a41e8e85-221.jpeg) Datavant ### [Health Information Specialist I](https://jobicy.com/jobs/146316-health-information-specialist-i.md) Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world’s health data secure, accessible and actionable, we provide critical data solutions for organizations… ![USA flag](https://cloud.jobicy.com/nyc4-cold/img/round-flags/us.svg) US•Full TimeUSD 30k-30k/year* ![Pfizer logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/ecae5aae-221.jpeg) Pfizer ### [Senior Oncology Account Specialist Prostate Cancer Bronx, West Chester, NY](https://jobicy.com/jobs/149257-senior-oncology-account-specialist-prostate-cancer-bronx-west-chester-ny.md) Role Summary Pfizer Commercial Oncology is introducing the world to the next era of cancer care. With a growing portfolio of novel therapies, industry-leading R&D, and a goal of delivering… ![USA flag](https://cloud.jobicy.com/nyc4-cold/img/round-flags/us.svg) US•Full TimeUSD 108,600-250,700/year* ![Pfizer logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/ecae5aae-221.jpeg) Pfizer ### [Senior Oncology Account Specialist Prostate Cancer Brooklyn, NY](https://jobicy.com/jobs/149256-senior-oncology-account-specialist-prostate-cancer-brooklyn-ny.md) Role Summary Pfizer Commercial Oncology is introducing the world to the next era of cancer care. With a growing portfolio of novel therapies, industry-leading R&D, and a goal of delivering… ![USA flag](https://cloud.jobicy.com/nyc4-cold/img/round-flags/us.svg) US•Full TimeUSD 108,600-250,700/year* ![Pfizer logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/ecae5aae-221.jpeg) Pfizer ### [Senior Oncology Account Specialist Lung Cancer Boston, MA](https://jobicy.com/jobs/149255-senior-oncology-account-specialist-lung-cancer-boston-ma.md) Role Summary Pfizer Commercial Oncology is introducing the world to the next era of cancer care. With a growing portfolio of novel therapies, industry-leading R&D, and a goal of delivering… ![USA flag](https://cloud.jobicy.com/nyc4-cold/img/round-flags/us.svg) US•Full TimeUSD 108,600-250,700/year [More Jobs](https://jobicy.com/jobs.md)