Remote Hospice Prior Authorization Nurse | Utilization Review

Centene; Town of Florida (NY); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene is seeking a Clinical Review Nurse - Prior Authorization (Hospice) to analyze prior authorization requests for medical necessity and appropriate levels of care. This role suits nurses with hospice and managed care experience and offers remote work within the United States.

Responsibilities include performing medical reviews, collaborating with providers, escalating to Medical Directors as needed, and maintaining comprehensive patient information in health management systems.

Qualifications

• Nursing degree or higher required.
• RN licensure preferred; LPN licensure required.

Responsibilities

• Perform medical necessity and clinical reviews of authorization requests.
• Work with healthcare providers and authorization team for timely service reviews.
• Coordinate with healthcare providers and interdepartmental teams to assess medical necessity.
• Escalate prior authorization requests to Medical Directors as needed.
• Assist with service authorization requests for member transfers or discharges.
• Collect, document, and maintain member clinical information in health management systems.
• Provide education to providers and interdepartmental teams on utilization processes.
• Offer feedback on opportunities to improve the authorization review process.
• Perform other duties as assigned.
• Comply with all policies and standards.

Education

Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing

RN licensure preferred

LPN licensure required

Job description

Centene is seeking a Clinical Review Nurse - Prior Authorization (Hospice) to analyze prior authorization requests for medical necessity and appropriate levels of care. This role suits nurses with hospice and managed care experience and offers remote work within the United States.

Responsibilities include performing medical reviews, collaborating with providers, escalating to Medical Directors as needed, and maintaining comprehensive patient information in health management systems.