Remote Clinical Review Nurse - Utilization & Care

Centene Management Company LLC; Texas; Híbrido; USD 37 000 - 67 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Resumo da oferta

Centene Corp. in Texas offers a remote RN role focused on medical necessity determinations for prior authorization requests. You will analyze clinical information, coordinate with medical teams, and ensure timely and compliant review of services.

Requirements include RN license and nursing degree, with 2–4 years of related experience. The role emphasizes education of providers and utilization process improvements to support high‑quality, cost‑effective care.

Qualificações

• Graduate from an Accredited School of Nursing or Bachelor’s in Nursing.
• 2–4 years of related experience in clinical reviews.
• Knowledge of Medicare/Medicaid regulations preferred.

Responsabilidades

• Analyzes prior authorization requests to determine medical necessity and level of care.
• Provides recommendations to medical teams to promote quality and cost effectiveness.
• Works with providers and authorization teams to ensure timely reviews.
• Escalates complex cases to Medical Directors as appropriate.
• Maintains all member clinical information in health management systems.

Conhecimentos

Clinical review & medical necessity

Regulatory knowledge

Provider collaboration

Formação académica

Nursing degree or BSN

RN license

Ferramentas

Health management systems

Descrição da oferta de emprego

Centene Corp. in Texas offers a remote RN role focused on medical necessity determinations for prior authorization requests. You will analyze clinical information, coordinate with medical teams, and ensure timely and compliant review of services.

Requirements include RN license and nursing degree, with 2–4 years of related experience. The role emphasizes education of providers and utilization process improvements to support high‑quality, cost‑effective care.