Medical Review Specialist III

Centene; United States; Remote; USD 80,000 - 100,000; Full time

Job summary

Join a forward-thinking organization as a clinical professional in the Medical Management/Health Services team, where your contributions can impact the lives of 28 million members. In this role, you will support peer-to-peer processes, manage workflows, and enhance communication between clinical staff and providers. The company values workplace flexibility, offering a range of work schedules including remote and hybrid options. With a commitment to diversity and inclusion, this is an opportunity to grow your career while making a meaningful difference in healthcare.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedule

Qualifications

• 2-4 years of related experience in medical management or health services.
• Strong knowledge of medical terminology and practices preferred.

Responsibilities

• Supports peer-to-peer (P2P) processes and manages workflows.
• Communicates effectively with providers and clinical staff.
• Identifies process improvements within the P2P process.

Skills

Medical Terminology

Communication Skills

Process Improvement

Education

High School Diploma or GED

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:

• Supports peer-to-peer (P2P) processes, including scheduling P2P between Medical Directors and providers according to internal policies and requirements.
• Manages and reviews Medical Director’s workflow queue in the medical management system and adjusts workflows as needed based on escalations and scheduling.
• Schedules peer-to-peer (P2P) between Medical Directors and providers to discuss clinical services including the approval of a prior authorization.
• Manages turn-around times for P2P authorizations to ensure P2P are conducted within a timely manner in accordance with regulations and policies.
• Develops in-depth knowledge of P2P process, best practices, and internal policies and requirements.
• Serves as front-line support in communicating with providers and/or vendors.
• Provides support with all communications between clinical staff, providers, and Medical Directors.
• Works with different teams to identify process improvements and efficiencies within the P2P process.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

Requires a High School diploma or GED. Requires 2 - 4 years of related experience. Strong knowledge of medical terminology and practices preferred.

Pay Range: $21.64 - $36.53 per hour.

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. Total compensation may also include additional forms of incentives.

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.