Remote Clinical Review Nurse – Utilization Management

Centene Corporation; New Jersey; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Paid time off + holidays

Flexible remote/hybrid/office work

Job summary

Centene Corporation is seeking a Nursing professional to analyze prior authorization requests for medical necessity and appropriate level of care. You will collaborate with medical directors, healthcare providers, and interdepartmental teams to promote quality and cost-effective care while maintaining compliance with regulatory guidelines.

The role supports a remote, full-time schedule with occasional weekend coverage and rotating holidays.

Qualifications

• Clinical knowledge to analyze authorization requests and determine medical necessity.
• Ability to work remotely within the United States and coordinate with medical teams.
• Knowledge of Medicare/Medicaid regulations is preferred.

Responsibilities

• Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness.
• Coordinates with healthcare providers and interdepartmental teams to assess medical necessity of care.
• Escalates prior authorization requests to Medical Directors as appropriate.

Skills

Clinical knowledge

Regulatory guidelines knowledge

Interdisciplinary collaboration

Health data documentation

Education

Bachelor’s degree in Nursing

Accredited nursing program graduate

Tools

Health management systems

Job description

Centene Corporation is seeking a Nursing professional to analyze prior authorization requests for medical necessity and appropriate level of care. You will collaborate with medical directors, healthcare providers, and interdepartmental teams to promote quality and cost-effective care while maintaining compliance with regulatory guidelines.

The role supports a remote, full-time schedule with occasional weekend coverage and rotating holidays.