Remote Clinical Review Nurse - Medicaid Care Leader
$27.02 - $48.55 per hourCentene
- Remote job
Centene is seeking a Clinical Review Nurse - Concurrent Review to perform concurrent reviews, assess medical necessity, and contribute to discharge planning. This role supports Medicaid and Marketplace/Ambetter members in a remote setting. The position offers full-time hours, with a pay range of $27.02–$48.55 per hour and requires nursing licensure (RN or LPN) with Nevada licensure where applicable, plus 2+ years of acute care experience. #J-18808-Ljbffr Centene
$27.02 - $48.55 per hour
...Business Area: Clinical & Care Management Job Type: Full... ...Performs concurrent reviews, including determining... ...Details: This position is remote/work from home. Prefer... ...unencumbered compact nursing license and Michigan... ...The role will support Medicaid and Market Place/...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hoursWeekend work- ...Position Title: Clinical Review Nurse - Concurrent Review Work Location: Remote (EST preferred but will consider CST) Assignment... ...health, reviewing the type of care being delivered, evaluating... ...2 Knowledge of Medicare and Medicaid regulations preferred. 3 Knowledge...Remote workWeekend work
$37 - $39 per hour
...Immediate need for a talented Clinical Review Nurse - Concurrent Review. This... ...and is located in U.S(Remote). Please review the job description... ...and appropriateness of care Assist in evaluating inpatient... ...denial letters for FL Medicaid Physical Health Codes Meet...Remote workContract workLocal areaImmediate startWeekend work- ...and appropriate level of care in accordance with... ...an Accredited School of Nursing or Bachelor's degree in... ...related experience. Clinical knowledge and ability to... ...Knowledge of Medicare and Medicaid regulations preferred.... ...necessity and clinical reviews of authorization...Remote workFlexible hours
- ...serve and 700,000 health care providers who care... ...Statement The Clinical Review Nurse is responsible for reviewing... ...discussion with CMS leaders and leaders in the... ...Centers for Medicare & Medicaid Services (CMS) may... ...opportunity is open to remote work in the following...Remote workPermanent employmentTemporary workWork at officeLocal areaImmediate start
- Centene seeks a licensed nurse to perform concurrent reviews of inpatient admissions for pediatric and adult members within the LA Medicaid line of business. The role focuses on determining... ...medical necessity and appropriate level of care, with standard hours 8am to 5pm CST...Remote jobWeekend work
- Centene Corp. is seeking a Clinical Review Nurse for concurrent reviews in a fully remote role, supporting Medicaid and Marketplace members. Requires RN or LPN licensure, nursing degree, and 2+ years acute care experience; compact licensure preferred. You will assess level...Remote jobMonday to Friday
$27.02 - $48.55 per hour
## Clinical Review Nurse - Concurrent ReviewApply: Remote-WA State: Full time: Posted Today: End Date: October 16, 2026 (... ...overall health, reviewing the type of care being delivered, evaluating... ...work from home, and will support Medicaid and Market Place/Ambetter members...Remote workHourly payFull timeMonday to Friday$27.02 - $48.55 per hour
About This Role The Clinical Review Nurse - Concurrent Review performs concurrent reviews... ...nurses looking to support Medicaid and Market Place/Ambetter members in a remote setting. Highlights Pay: $27.02... ...reviews of members for appropriate care and setting Review quality and...Remote workHourly payFull timeWork at officeMonday to FridayFlexible hours$35 - $45 per hour
...Position Title: Clinical Review Nurse - Concurrent Review Location: Remote, Compact Nursing License Required, Central Time... ...reviews of members for appropriate care and setting to determine overall... ...experience, specifically with Medicaid, True Care Cloud experience is a...Remote workShift workWeekend work- ...Job Title: Clinical Review Nurse - Concurrent Review Location: Remote Duration: 12 months XXXX: XXXXXXXXXXX/hr.... ...overall health, reviewing the type of care being delivered, evaluating... ...Knowledge of Medicare and Medicaid regulations preferred. Knowledge...Remote workHourly payShift work
- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews of Medicaid-related assessments (H6516/H2060), evaluate records, and provide independent clinical judgments on medical necessity. Requirements include a Texas RN license...Remote jobFlexible hours
- ...considered ************** Title: HEDIS Clinical Medical Review Nurse Location: Columbia, MD 21044 (... ...5 months Work Location: Primarily Remote (Hybrid focus for candidates residing... ...compliance and high standards of care. Key Responsibilities: Conduct...Remote workContract workWork at officeLocal area
$24.91 - $40.07 per hour
...Health Plans is hiring a Care Coordinator for LTSS Waiver Members/Medicaid - Remote in Northern Virginia (... ...-Music Therapy -Nursing -Pharmacy -Psychiatric... ...United States will be reviewed individually.**Certification... ...programs, and integrated clinical and behavioral health services...Remote jobHourly payPermanent employmentFull timeTemporary workHome officeShift work- Medix™ is seeking an experienced Registered Nurse (RN) to join our Utilization Review team in a remote capacity. The role evaluates medical necessity, reviews levels of care, and supports denial prevention and appeals across the continuum of care. The ideal candidate will...Remote job
- ...Position Title: Clinical Review Nurse - Prior Authorization Work Location: Remote; nationally sourced within approved U.S. states. Must be available during standard... ...experience; utilization management, managed care, or prior authorization experience preferred....Remote workWork at officeMonday to Friday
- ...Summary: Work Mode: 100% Remote - MS (candidates can be... ...medical necessity reviews of inpatient admissions... ...continued stays. Apply clinical criteria and guidelines... ...determinations within nursing scope. Identify... ...compliance, safe transitions of care, reduced length of stay...Remote workHourly payFlexible hoursShift workWeekend work
- ...Position Title : Clinical Review Nurse - Concurrent Review Work Location : Remote - Central, Mountain or Pacific preferred Assignment Duration : 6 months (temp... ...the member's current clinical status, level of care, functional needs, treatment plan, progress, and...Remote workTemporary work
- Centene Corporation is seeking a Licensed Practical Nurse (LPN) or Registered Nurse (RN) for a remote case management role in Pennsylvania. The selected candidate will perform concurrent reviews, determine appropriate care levels, and assist with discharge planning to...Remote job
$30 - $45 per hour
...Beach, CA. This role requires expertise in Medicaid and Medi-Cal operations, along with experience in Epic EHR and Utilization Review. The selected candidate will perform chart... ...Medicaid program metrics. This position is remote and offers a pay range of $30-$45 per hour...Remote workHourly payContract work- A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare... ...are essential for maintaining high-quality care. This 12-month contract position offers...Remote jobContract work
- ...Clinical Review Nurse I Clinical Review Nurse I Virtual: This role enables associates to work... ...in the healthcare industry, looking for leaders at all levels of the organization who are... ...awareness resources at HB531 | Florida Agency for Health Care Administration....Remote workFull timeTemporary workWork at officeLocal areaDay shift1 day per week
- Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform concurrent reviews, assess care necessity, and contribute to discharge planning, leveraging case management or utilization management experience....Remote jobFull timeShift workDay shift
- Elevance Health is seeking a Clinical Review Nurse I for the Wellpoint Federal division. This role reviews claims, applying medical policy to determine if benefits align with member coverage and requirements, ensuring accuracy and timely decisions. The position offers virtual...Remote jobMonday to Friday
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant,... ...company in the US and a leader across several... ...including Medicare, Medicaid, and Commercial Healthcare... ...matter most - quality of care and healthier lives... .... You will work remotely in a fast paced and dynamic...Remote workFor contractorsWork at officeWork from homeHome officeShift work- ...Clinical Medical Review Nurse We are seeking Licensed Practical Nurses (LPN) or Registered Nurses (RN) to join the Quality team as Clinical Medical... ...Nurses. This is a hybrid contract position requiring both remote work and regular onsite presence at the Canton, MD office....Remote workContract workWork at office
- ...Clinical Medical Review Nurse HEDIS Retrospective Project Lumen Solutions Group Inc. is a technology consulting Services company based in Florida... ...conducting overreads. The position is primarily remote, with occasional onsite provider visits. Provider visits are...Remote work
- ...Clinical Medical Review Nurse Ampcus Inc. is a certified global provider of a broad range of Technology... ...systems. Identify trends, gaps in care, and opportunities for improved health... ...professionalism and a collaborative mindset. Remote work environment with minimal physical...Remote work
- Position Title Clinical Review Nurse - Prior Authorization Work Location Remote - PST and CST (No CA and NY candidates please) Assignment Duration 12 Months Work... ...medical necessity of service and appropriate level of care in accordance with national standards,...Remote workFlexible hoursShift work
$21 per hour
...viability of the claim for further review in a production environment.... ...Key Responsibilities: Clinical Case Reviews - 75% Perform... ...Coding Certificate and/or Nursing Licensure Complete compliance... ...could change to hybrid or remote after the 8-week training....Remote workHourly payFull timeContract workTemporary workMonday to Friday
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