Clinical Review Nurse – Concurrent Review (Remote)

About the role

Centene is seeking a Clinical Review Nurse to perform concurrent reviews for members across its health plan in Oregon. This fully remote position evaluates medical necessity, quality of care, and discharge planning to ensure members receive appropriate treatment.

Key responsibilities

• Conduct concurrent reviews of inpatient services, assessing health status, acuity, resource use, length of stay, and discharge plans.
• Collaborate with Medical Affairs, Medical Directors, and providers to discuss care decisions and approve or recommend services.
• Document findings, discharge plans, and actions in health‑management systems according to utilization management policies.
• Provide education to providers on utilization processes and offer feedback to leadership on care appropriateness.
• Review transfer and discharge plans to facilitate timely transitions between care settings.
• Partner with care management on member referrals and perform other duties as assigned.

Required profile

• Graduate of an accredited nursing program (BSN) with 2–4 years of related experience.
• Minimum 2 years of acute‑care nursing experience.
• State licensure as an LPN or RN (OR license required or willingness to obtain).
• Knowledge of Medicare and Medicaid regulations and utilization management processes preferred.

Required skills

• Ability to assess overall health, treatment needs, and appropriate level of care.
• Proficiency in documenting clinical findings in health‑management systems.
• Strong understanding of medical necessity criteria and discharge planning.

What we offer

• Competitive hourly pay ranging from $27.02 to $48.55.
• Comprehensive benefits including health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off and holidays.
• Flexible work arrangements with 100% remote capability.