RN Clinical Review Nurse - Prior Authorization
Centene Corporation · United States · US
Utilization Review
Remote/Hybrid — check advert
Nurse
physiotherapist
occupational_therapist
Demand82
Career growth68
Healthcare fit88
Remote potential70
Salary band
USD 27 – 49
5-year outlook
Posted hourly range is $27.02-$48.55. Over 3-5 years, pay growth likely depends on licensure, payer/utilization management experience, and progression into senior review, audit, or team lead roles.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-25
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, physiotherapist, occupational_therapist
- 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 licensed nurses or allied clinicians who want a non-bedside payer utilization review role with predictable workflow and Medicare/Medicaid exposure. Verify the RN versus LPN licensure requirement and remote/hybrid expectations before applying.
Who should apply
RNs/LPNs with 2-4 years of clinical experience, especially those with Medicare/Medicaid, discharge planning, case management, or utilization review exposure. Allied health clinicians such as PT/OT may fit Fidelis-specific clinical degree requirements.
CV angle
Frame bedside or clinical experience as evidence of medical necessity assessment, clinical documentation, interdisciplinary communication, discharge/transition planning, and regulatory compliance. Quantify authorization, case, or patient volumes and highlight any real payer, Medicare/Medicaid, or utilization management exposure.
Skills to highlight
- Medical necessity review
- Prior authorization
- Utilization management
- Medicare/Medicaid regulations
- Clinical documentation
- Discharge and transition planning
- Provider communication
- Regulatory compliance
Role summary
Reviews prior authorization and service authorization requests, assesses medical necessity, documents clinical information, escalates complex cases to medical directors, and supports utilization management processes for members.
We publish our own intelligence summary, never the full job description. Always confirm details with the employer when you apply.