Remote Clinical Appeals & Utilization Coordinator

Centene Management Company LLC; Nebraska; Híbrido; USD 46.000 - 84.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible remote/hybrid/office work

Descripción de la vacante

Centene Management Company LLC is seeking an experienced RN/LPN/LVN to act as liaison for statewide appeals and fair hearings. You will review clinical data to assess medical necessity and prepare compliant response letters for members and providers.

The role requires coordinating with Medical Directors and maintaining thorough appeal files, with emphasis on NCQA and state regulations. Experience in utilization management or managed care is preferred.

Formación

• RN with 4+ years of clinical nursing and/or case management experience.
• Licensed RN, LPN or LVN; state license required.
• Managed care or utilization review experience preferred.

Responsabilidades

• Act as liaison for statewide appeals and fair hearings.
• Review clinical information to determine medical necessity.
• Prepare and customize review letters meeting state and NCQA standards.

Conocimientos

RN experience

Case management

Utilization review

Educación

Master’s degree in area of specialty therapy

Descripción del empleo

Centene Management Company LLC is seeking an experienced RN/LPN/LVN to act as liaison for statewide appeals and fair hearings. You will review clinical data to assess medical necessity and prepare compliant response letters for members and providers.

The role requires coordinating with Medical Directors and maintaining thorough appeal files, with emphasis on NCQA and state regulations. Experience in utilization management or managed care is preferred.