Remote Clinical Review Nurse - Utilization & Authorization

Centene Corporation; New York (NY); Remote; USD 70,000 - 100,000; Full time

Job summary

Centene Corporation is seeking a nursing professional to analyze prior authorization requests for medical necessity and the appropriate level of care, coordinating with providers and the medical team to ensure timely, compliant reviews.

The role offers remote work from anywhere in the United States with a full-time schedule (Mon–Fri, 8:00 a.m.–5:00 p.m. local time). Weekend coverage occurs about every six weeks, with rotating holidays and flexible scheduling for those hours.

Qualifications

• Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience.
• Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
• Knowledge of Medicare and Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.

Responsibilities

• Analyze all prior authorization requests to determine medical necessity and appropriate level of care.
• Provide recommendations to the medical team to promote quality and cost effectiveness.
• Collaborate with healthcare providers and authorization team to ensure timely reviews.
• Coordinate with interdepartmental teams to assess medical necessity of care for members.

Skills

Clinical knowledge

Nursing experience

Utilization management

Regulatory knowledge

Education

Graduate from an Accredited School of Nursing

Bachelor's degree in Nursing

Job description

Centene Corporation is seeking a nursing professional to analyze prior authorization requests for medical necessity and the appropriate level of care, coordinating with providers and the medical team to ensure timely, compliant reviews.

The role offers remote work from anywhere in the United States with a full-time schedule (Mon–Fri, 8:00 a.m.–5:00 p.m. local time). Weekend coverage occurs about every six weeks, with rotating holidays and flexible scheduling for those hours.