Clinical Review Nurse - Concurrent Review

Clinical Review Nurse:

Description

Duals Program Details- Brand new program of 2026 for Centene

Duals = Medicare + Medicaid line of business. Members have one combined card and one authorization covering both benefit types.

The duals program is currently active in eight states:

Cloud Charting: Delaware, Iowa, Texas

Classic Platform: Arizona, Illinois, Michigan, Ohio, South Carolina

Additional states may be added in 2027.

They are managing both Medicare and Medicaid requirements simultaneously, which increases complexity.

They are handling inpatient concurrent review and average 1.85 cases per hour.

Skills

clinical review, RN license, prior authorization, utilization management, concurrent review, interqual, managed care, medical management, acute care, medicaid, medicare

Additional Skills & Qualifications

Experience:

Prefer RNs with Utilization Management (UM) experience.

Experience with outpatient prior authorization

Strong preference for InterQual experience (not just MCG).

Must have strong computer skills.

Licensure:

RNs only — no LPNs. Must have a compact license

Training:

Approximately 2 weeks of training.

Followed by assignment to a preceptor/mentor.

Schedule:

Start time around 9 or 10 AM; candidates may sit wherever they prefer.

Must work in their own time zone.

Must be able to work as late as 7 PM.

Job Type & Location

This is a Contract to Hire position based out of St. Louis, MO.

Pay and Benefits

The pay range for this position is $34.00 - $40.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Jun 18, 2026.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email View email address on click.appcast.io for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.