Clinical Review Nurse Jobs
Clinical Review Nurse jobs are open across health insurance, managed care, workers' compensation, and hospital utilization management, from staff-level to lead and supervisor, with specializations in prior authorization, case management, and utilization review. See the openings below and apply to the ones that match your experience.
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Showing 5 of 55+ Clinical Review Nurse jobs
Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
Key Details: Remote Role. Texas RN License Required.
- Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
- Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
- Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member
- Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care
- Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities
- Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines
- Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members
- Provides feedback on opportunities to improve the authorization review process for members
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.
Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
Knowledge of Medicare and Medicaid regulations preferred.
Knowledge of utilization management processes preferred.
License/Certification:
- For Superior Health Plan: RN license required
Pay Range: $27.02 - $48.55 per hour
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
Key Details: Remote Role. Texas RN License Required.
- Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
- Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
- Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member
- Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care
- Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities
- Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines
- Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members
- Provides feedback on opportunities to improve the authorization review process for members
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.
Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
Knowledge of Medicare and Medicaid regulations preferred.
Knowledge of utilization management processes preferred.
License/Certification:
- For Superior Health Plan: RN license required
Pay Range: $27.02 - $48.55 per hour
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
Clinical Review Nurse Jobs by Experience Level
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Find Clinical Review Nurse JobsClinical Review Nurse Job Market
Who's Hiring
Top Industries Hiring
- Technology & Software
- Government & Public Sector
- Healthcare & Medical Services
- Insurance
- Consulting & Professional Services
What Employers Look For
The qualifications that appear most often in clinical review nurse jobs.
- Active registered nurse license with no restrictions, required in all states of practice
- Minimum two years of clinical nursing experience in an acute care or relevant specialty setting
- Working knowledge of InterQual or Milliman evidence-based criteria for coverage determinations
- Experience with utilization review, prior authorization, or concurrent inpatient review processes
- Proficiency in documenting clinical rationale within care management or claims platforms
- Certified Case Manager (CCM) or URAC-recognized utilization management certification preferred
Tips for Your Clinical Review Nurse Job Search
Tailor your resume for utilization management
Highlight your experience with InterQual or Milliman criteria directly on your resume. Reviewers scan for these tools immediately, and a resume that buries them in a skills list instead of pairing them with outcomes will be passed over.
Distinguish authorization from concurrent review experience
Prior authorization and concurrent inpatient review are distinct workflows. Identify which one dominates each job posting and lead with the matching experience in your summary. Blending them together signals you haven't read the posting carefully.
Apply early to roles that fit
Migrate Mate lists clinical review nurse openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Target postings by payer type, not just title
Commercial insurance, Medicare Advantage, and workers' compensation plans each have different documentation standards and regulatory frameworks. Search for the payer type you know best, since interviews will probe your familiarity with that specific environment.
Prepare clinical rationale examples before your interview
Interviewers for clinical review roles routinely ask you to walk through a denial or approval decision using evidence-based criteria. Prepare two or three real case scenarios where you applied criteria to a coverage decision and can explain your reasoning clearly.
Negotiate schedule and caseload, not just pay
Remote clinical review positions often come with high daily case volume expectations. Before accepting an offer, ask what the average daily case count is and whether production metrics affect your standing, so you're not surprised after your first week.
Clinical Review Nurse Jobs: Frequently Asked Questions
Which companies are hiring the most clinical review nurses?
The companies hiring the most clinical review nurses right now include Optum, Adventist Health, and UCLA Health, with the largest share of openings in California, Texas, and Minnesota, based on current listings on Migrate Mate as of November 2026. Health insurance carriers and managed care organizations account for the majority of active postings.
How many clinical review nurse jobs are remote?
About 63% of clinical review nurse openings are fully remote or hybrid as of November 2026, making it one of the more remote-accessible nursing specialties. Prior authorization review and telephonic utilization management roles are most likely to be fully remote, while on-site concurrent review positions tied to a specific hospital or health system are less commonly remote.
How do you become a clinical review nurse?
Start by earning your registered nurse license and working at least two years in a clinical setting, ideally in a specialty relevant to the cases you'll review, such as med-surg, orthopedics, or behavioral health. From there, seek a staff-level utilization review or prior authorization role to build familiarity with evidence-based criteria tools. Pursuing a Certified Case Manager credential strengthens your candidacy for more senior positions.
Can you get a clinical review nurse job without prior review experience?
Yes, some employers hire clinically experienced RNs into entry-level utilization review roles and provide on-the-job training on criteria tools and documentation systems. Your strongest asset is deep clinical knowledge in a specialty the employer reviews frequently. Highlight any exposure to discharge planning, care coordination, or insurance authorization in your current role, since those workflows overlap directly with clinical review.
What does the clinical review nurse interview process look like?
Most clinical review nurse interviews include a phone screen with a recruiter followed by one or two video interviews with a clinical manager or director. Expect scenario-based questions where you walk through how you would apply evidence-based criteria to a specific case type. Some employers add a short written exercise or a criteria application simulation. The process typically moves quickly compared to bedside nursing hiring.
Where can I find and apply to clinical review nurse jobs?
You can find and apply to clinical review nurse jobs on Migrate Mate, which lists current openings from across the United States. Search for roles that match your specialty background and experience level, then apply directly to each listing that fits.
See All 55 Clinical Review Nurse Jobs
Find roles that match your experience and apply in just a few clicks.
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