Remote Prior Authorization Nurse - Clinical Review Pro

Centene; Texas; Remote; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

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 for a remote position based in Texas. This role focuses on analyzing authorization requests to determine medical necessity and appropriate levels of care, leveraging utilization management knowledge and regulatory guideline understanding.

The position offers remote work with full-time hours, competitive hourly pay, and benefits. The ideal candidate will have RN licensure, 2–4 years of related experience, and the ability to educate

Qualifications

• RN licensure required and active
• 2–4 years of related nursing experience in utilization management or prior authorization
• Knowledge of medical necessity reviews and regulatory guidelines

Responsibilities

• Analyze prior authorization requests for medical necessity and appropriate level of care.
• Collaborate with providers and authorization teams for timely reviews.
• Coordinate with interdepartmental teams to assess medical necessity and escalate as needed.
• Educate providers and teams on utilization processes and feedback on process improvements.
• Maintain and document member clinical information in health management systems.
• Comply with all policies and standards.

Education

Graduate from Accredited School of Nursing

Bachelor's degree in Nursing

Job description

Centene is seeking a Clinical Review Nurse - Prior Authorization for a remote position based in Texas. This role focuses on analyzing authorization requests to determine medical necessity and appropriate levels of care, leveraging utilization management knowledge and regulatory guideline understanding.

The position offers remote work with full-time hours, competitive hourly pay, and benefits. The ideal candidate will have RN licensure, 2–4 years of related experience, and the ability to educate