Remote Clinical Review Nurse (Utilization & Authorization)

Centene Corporation; Iowa City (IA); Teletrabalho; USD 75 000 - 110 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Resumo da oferta

Centene Corporation seeks a licensed nurse to analyze prior authorization requests, determine medical necessity, and promote appropriate levels of care. The role collaborates with healthcare providers and internal teams to ensure timely reviews and compliant documentation across health management systems.

The position supports provider education on utilization processes, escalation to Medical Directors when needed, and discharge planning, offering flexible remote work options within the United

Qualificações

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing with 2–4 years of related experience.
• Knowledge of Medicare and Medicaid regulations.
• Knowledge of utilization management processes.

Responsabilidades

• Analyze prior authorization requests to determine medical necessity of service and appropriate level of care.
• Coordinate with healthcare providers and authorization team for timely reviews.
• Escalate authorization requests to Medical Directors as appropriate.
• Assist with service authorization requests for transfer or discharge planning.
• Collect, document, and maintain members' clinical information in health management systems.
• Educate providers and interdepartmental teams on utilization processes.
• Provide feedback to improve the authorization review process.
• Perform other duties as assigned.

Conhecimentos

Clinical knowledge

Authorization review

Regulatory knowledge

Communication

Formação académica

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Descrição da oferta de emprego

Centene Corporation seeks a licensed nurse to analyze prior authorization requests, determine medical necessity, and promote appropriate levels of care. The role collaborates with healthcare providers and internal teams to ensure timely reviews and compliant documentation across health management systems.

The position supports provider education on utilization processes, escalation to Medical Directors when needed, and discharge planning, offering flexible remote work options within the United