Remote Clinical Review Nurse – Prior Authorization

Centene Corporation; Kansas; Remote; USD 65,000 - 85,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Job summary

Centene Corporation seeks an LPN/RN with medical necessity review experience to assess prior authorization requests and determine appropriate level of care. This full-time role offers remote work from anywhere in the United States and standard M–F hours with occasional weekend coverage in a local time zone.

You will collaborate with medical directors, providers, and internal teams to promote timely, cost effective care, document clinical information, and ensure compliance with Medicare/Medicaid

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2–4 years of related experience.
• Clinical knowledge to analyze authorization requests and determine medical necessity.
• Knowledge of Medicare and Medicaid regulations preferred.

Responsibilities

• Performs medical necessity and clinical reviews of authorization requests.
• Works with providers and authorization teams to ensure timely review of services.
• Coordinates with interdepartmental teams to assess medical necessity.
• Escalates to Medical Directors as appropriate for care appropriateness.
• Documents and maintains all member clinical information in health systems.

Skills

Clinical reviews

Utilization management

Regulatory knowledge

Provider communication

Education

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Tools

Health management systems

Medicare/Medicaid guidelines

Job description

Centene Corporation seeks an LPN/RN with medical necessity review experience to assess prior authorization requests and determine appropriate level of care. This full-time role offers remote work from anywhere in the United States and standard M–F hours with occasional weekend coverage in a local time zone.

You will collaborate with medical directors, providers, and internal teams to promote timely, cost effective care, document clinical information, and ensure compliance with Medicare/Medicaid