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Clinical Review Nurse - Prior Authorization

Centene Corporation · United States · US

Utilization Review
Remote/Hybrid — check advert
Nurse
Demand82
Career growth66
Healthcare fit78
Remote potential62
Salary band
USD 27 – 49
5-year outlook
Payer-side utilization review roles typically offer stable, predictable compensation with modest annual increases and internal mobility into senior review, audit, or UM leadership. The posted hourly band suggests meaningful upside for RN-credentialed candidates versus LPN, and remote/hybrid flexibility adds practical value even if base pay growth is gradual.
Clinical license
Required
Applicant reach
broad
Seniority
mid
Employment type
full-time
Date found
2026-10-03

Intelligence details

Flexible work details

Side income
Classified as side-income friendly
Engagement type
Permanent
Hours
Full-time
Eligible countries
United States
License jurisdiction
US
Profession fit
Nurse
Rate period
Hourly

Why this was classified this way

  • part-time

Listing via Himalayas.

Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.

Why this is worth applying to

Worth applying for nurses seeking a structured, Monday–Friday payer-side role with remote/hybrid potential and a clear exit from bedside scheduling. Candidates without prior authorization or utilization management exposure should expect a steeper learning curve and stronger competition.

Who should apply

RNs and LPNs with 2–4 years of clinical experience, especially those with prior authorization, utilization management, case management, discharge planning, or Medicare/Medicaid exposure. Nurses with behavioral health, pediatric, or foster care population experience are particularly well matched.

CV angle

Reframe bedside or care coordination experience around medical necessity decision-making, payer criteria application, and documentation accuracy. Quantify authorization volumes, turnaround times, and interdepartmental coordination where possible, and explicitly name Medicare/Medicaid familiarity, discharge planning, and EHR/health management system proficiency. If you have prior auth or UM exposure, lead with it; if not, translate case management and care transition work into utilization review language without overstating scope.

Skills to highlight

  • Prior authorization and service authorization review
  • Medical necessity determination against regulatory criteria
  • Utilization management processes
  • Medicare and Medicaid regulatory knowledge
  • Care coordination and discharge planning
  • Clinical documentation in health management systems
  • Provider and interdepartmental education
  • Behavioral health and foster care population experience

Role summary

A payer-side clinical review nurse position at Centene performing medical necessity and clinical reviews of medical and behavioral health authorization requests for foster care members. The role coordinates with providers and internal teams, escalates complex cases to Medical Directors, supports discharge and transfer planning, documents clinical information in health management systems, and educates providers on utilization processes. Monday–Friday, 8am–5pm, with flexible remote/hybrid/office arrangements.

We publish our own intelligence summary, never the full job description. Always confirm details with the employer when you apply.