Remote Clinical Review Nurse – Utilization & Authorization

Centene Corporation; Little Rock (AR); Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off & holidays

Remote work with flexible scheduling

Job summary

Centene Corporation is seeking a Nursing professional to analyze prior authorization requests, determine medical necessity, and coordinate with the medical team to ensure appropriate care across diverse patient populations.

The role supports providers in utilization processes and requires strong clinical knowledge and experience in Medicare/Medicaid guidelines. Remote work is available nationwide with weekend coverage periodically.

Qualifications

• Requires RN/LPN licensure and 2–4 years of related experience.
• Clinical knowledge to analyze authorization requests and determine medical necessity.
• Knowledge of Medicare/Medicaid regulations preferred.
• Understanding utilization management processes preferred.

Responsibilities

• Analyze prior authorization requests to determine medical necessity.
• Collaborate with medical teams to promote timely review and appropriate care.
• Educate providers and interdepartmental teams on utilization processes.
• Escalate complex cases to Medical Directors as needed.
• Maintain clinical information in health management systems to ensure compliance.
• Assist with discharge planning to ensure timely transitions between levels of care.
• Provide feedback to improve authorization review processes.

Skills

LPN licensure

Nursing experience

Utilization management

Medicare/Medicaid knowledge

Education

Bachelor's degree in Nursing

Graduate from Accredited School of Nursing

Job description

Centene Corporation is seeking a Nursing professional to analyze prior authorization requests, determine medical necessity, and coordinate with the medical team to ensure appropriate care across diverse patient populations.

The role supports providers in utilization processes and requires strong clinical knowledge and experience in Medicare/Medicaid guidelines. Remote work is available nationwide with weekend coverage periodically.