Remote Clinical Review Nurse—Prior Authorization

Centene Corporation; Alabama; Remoto; USD 65.000 - 90.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Descrizione del lavoro

Centene Corporation is seeking a Nurse Reviewer to analyze prior authorization requests for medical necessity and appropriate level of care, ensuring compliance with regulatory guidelines and member benefits.

The role is full-time and remote nationwide, with weekday hours and occasional weekend coverage every six weeks, plus rotating holidays. Requires nursing licensure (LPN or RN) and 2–4 years of related experience, with benefits including health insurance and retirement plans.

Competenze

• Requires RN licensure (LPN may be acceptable depending on setting).
• Clinical knowledge to analyze authorization requests and determine medical necessity.
• Knowledge of Medicare/Medicaid and utilization management preferred.

Mansioni

• Perform medical necessity and clinical reviews of authorization requests.
• Collaborate with healthcare providers and authorization team to ensure timely reviews.
• Escalate appropriate requests to Medical Directors for determination.

Formazione

Graduate from an Accredited School of Nursing

Bachelor’s degree in Nursing

Descrizione del lavoro

Centene Corporation is seeking a Nurse Reviewer to analyze prior authorization requests for medical necessity and appropriate level of care, ensuring compliance with regulatory guidelines and member benefits.

The role is full-time and remote nationwide, with weekday hours and occasional weekend coverage every six weeks, plus rotating holidays. Requires nursing licensure (LPN or RN) and 2–4 years of related experience, with benefits including health insurance and retirement plans.