RN Clinical Review & Authorization Specialist (Remote)

Centene Corporation; United States; Hybrid; USD 37,000 - 67,000; Full time

Job summary

Centene Corporation is seeking an experienced nursing professional to analyze prior authorization requests to determine medical necessity and appropriate level of care. You will collaborate with medical directors and providers to ensure timely reviews, maintain comprehensive clinical information in health management systems, and educate teams on utilization management processes.

Requirements include graduation from an accredited nursing program or BSN, and an active nursing license (LPN

Qualifications

• Graduate of an accredited nursing program or BSN required.
• Licensed Practical Nurse (LPN) license required; RN considered where applicable.
• 2–4 years of related authorization review experience preferred.

Responsibilities

• Analyze prior authorization requests to determine medical necessity.
• Collaborate with medical directors and providers to ensure timely reviews.
• Maintain clinical information in health management systems to ensure compliance.
• Educate providers on utilization management processes.

Skills

Clinical knowledge

Authorization reviews

Regulatory awareness

Education

Bachelor's degree in Nursing

Accredited nursing program graduate

Job description

Centene Corporation is seeking an experienced nursing professional to analyze prior authorization requests to determine medical necessity and appropriate level of care. You will collaborate with medical directors and providers to ensure timely reviews, maintain comprehensive clinical information in health management systems, and educate teams on utilization management processes.

Requirements include graduation from an accredited nursing program or BSN, and an active nursing license (LPN