Remote Clinical Review Nurse – Concurrent Review (RN) – Compact License

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.

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.