Remote Clinical Review Nurse – Utilization & Care

Centene Management Company LLC; Town of Florida (NY); Hybrid; USD 52,000 - 76,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off + holidays

Remote work options

Job summary

Centene Management Company LLC is seeking a licensed practical nurse (LPN) to review prior authorization requests for medical necessity and appropriate care levels. The role supports collaboration with medical teams to ensure timely, appropriate authorizations.

This full-time, remote position offers weekday hours with occasional weekend coverage and holidays, requiring knowledge of Medicare/Medicaid rules and effective provider communication. Email [e-mail] for applications.

Qualifications

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

Responsibilities

• Perform medical necessity and clinical reviews of authorization requests.
• Coordinate with providers and authorization team to ensure timely review.
• Escalate cases to Medical Directors when appropriate.
• Assist with service authorization for transfers or discharges to ensure timely care.
• Document and maintain member clinical information in health systems.

Skills

Clinical reviews

Medical necessity analysis

Regulatory knowledge

Provider education

Time management

Education

LPN licensure

Bachelor's in Nursing

RN licensure (preferred)

Tools

Health management systems

Job description

Centene Management Company LLC is seeking a licensed practical nurse (LPN) to review prior authorization requests for medical necessity and appropriate care levels. The role supports collaboration with medical teams to ensure timely, appropriate authorizations.

This full-time, remote position offers weekday hours with occasional weekend coverage and holidays, requiring knowledge of Medicare/Medicaid rules and effective provider communication. Email [e-mail] for applications.