Remote Clinical Review Nurse – Utilization Management

Centene Corp.; New York (NY); Híbrido; USD 37.000 - 67.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive pay

Health insurance

401K

Descripción de la vacante

Centene Corp. is seeking a remote RN to perform prior authorization reviews in New York. You will assess medical necessity, collaborate with providers and the authorization team, and help ensure timely, appropriate care for members.

The role requires a NY RN license and weekday hours 8:30 AM–5:00 PM ET with a one-hour lunch. Benefits include competitive pay, health insurance, 401K and more.

Formación

• Bachelor’s degree in Nursing (BSN) or graduation from an accredited school of nursing, plus 2 to 4 years of related experience.
• Clinical knowledge and ability to analyze authorization requests and determine medical necessity.
• Knowledge of Medicare and Medicaid regulations.
• Knowledge of utilization management processes.

Responsabilidades

• Analyzes all prior authorization requests to determine medical necessity of service and level of care.
• Works with healthcare providers and authorization team to ensure timely review of services.
• Coordinates with healthcare providers and interdepartmental teams to assess medical necessity.
• Escalates authorization requests to Medical Directors as appropriate.
• Assists with service authorization for transfers or discharge plans to ensure timely care.
• Collects and maintains member clinical information to ensure regulatory compliance.
• Provides education to providers on utilization processes and identifies process improvements.

Conocimientos

Clinical review

Regulatory knowledge

Utilization management

Educación

BSN or nursing degree

2–4 years related experience

Descripción del empleo

Centene Corp. is seeking a remote RN to perform prior authorization reviews in New York. You will assess medical necessity, collaborate with providers and the authorization team, and help ensure timely, appropriate care for members.

The role requires a NY RN license and weekday hours 8:30 AM–5:00 PM ET with a one-hour lunch. Benefits include competitive pay, health insurance, 401K and more.