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:
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Jun 18, 2026.
About Actalent
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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 actalentaccommodation@actalentservices.com 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.
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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.