Remote Clinical Review Nurse – Prior Authorization

Centene Corporation; Tallahassee (FL); Remote; USD 70.000 - 90.000; Vollzeit

Benefits dieser Stelle

Health insurance

401K plan

Tuition reimbursement

Paid time off

Remote work options

Zusammenfassung

Centene Corporation seeks a Nurse Reviewer to analyze prior authorization requests and determine medical necessity in line with regulatory guidelines and member benefits. You will collaborate with medical directors, providers, and the authorization team to ensure timely care and appropriate levels of service.

Remote-friendly role within the United States, full-time, Monday–Friday with occasional weekend coverage as described.

Qualifikationen

• RN with Bachelor's in Nursing and 2–4 years of related experience.
• Knowledge of Medicare/Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.

Aufgaben

• Analyze prior authorization requests to determine medical necessity.
• Coordinate with healthcare providers and authorization team to ensure timely reviews.
• Escalate cases to Medical Directors as appropriate.
• Maintain member clinical information in health management systems.
• Educate providers on utilization processes to improve care.

Kenntnisse

Nursing

RN licensure

Clinical reviews

Utilization management

Ausbildung

Bachelor’s degree in Nursing

Jobbeschreibung

Centene Corporation seeks a Nurse Reviewer to analyze prior authorization requests and determine medical necessity in line with regulatory guidelines and member benefits. You will collaborate with medical directors, providers, and the authorization team to ensure timely care and appropriate levels of service.

Remote-friendly role within the United States, full-time, Monday–Friday with occasional weekend coverage as described.