Remote Clinical Review Nurse – Utilization & Authorization

Centene Corporation; Kansas; À distance; USD 70 000 - 95 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Résumé du poste

Centene Corporation in the United States is seeking a Nursing professional to analyze prior authorization requests and determine medical necessity and level of care in line with standards and coverage. You will collaborate with medical teams to promote quality and cost-effective care.

Requires an accredited nursing degree and 2–4 years of related experience; RN licensure preferred. This role offers full-time remote-friendly scheduling with occasional weekend coverage and holidays, based in the

Qualifications

• Nursing degree required with clinical knowledge in utilization management.
• Experience evaluating authorization requests and determining medical necessity preferred.
• Knowledge of Medicare/Medicaid regulations is preferred.

Responsabilités

• Performs medical necessity and clinical reviews of authorization requests.
• Coordinates with providers and internal teams to ensure timely reviews and appropriate care.
• Escalates authorization decisions to Medical Directors as needed.
• Supports discharge planning and transfers to ensure smooth transitions between levels of care.
• Maintains patient information in health management systems in compliance with regulations.
• Educates providers and teams on utilization processes to improve efficiency.
• Provides feedback to improve the review process.

Connaissances

Clinical review

Medical necessity evaluation

Regulatory knowledge

Communication with providers

Formation

Graduate from an Accredited School of Nursing

Bachelor’s degree in Nursing

Description du poste

Centene Corporation in the United States is seeking a Nursing professional to analyze prior authorization requests and determine medical necessity and level of care in line with standards and coverage. You will collaborate with medical teams to promote quality and cost-effective care.

Requires an accredited nursing degree and 2–4 years of related experience; RN licensure preferred. This role offers full-time remote-friendly scheduling with occasional weekend coverage and holidays, based in the