RN Clinical Review Nurse - Prior Authorization (Remote)

Centene Management Company LLC

New York (NY)

Hybrid

USD 37,000 - 67,000

Full time

5 days ago

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Benefits offered by this job

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off & holidays

Flexible work arrangements

Job summary

Centene Management Company LLC is seeking a Licensed Practical Nurse to analyze prior authorization requests and determine medical necessity in New York. You will work with healthcare providers and the authorization team to ensure timely, appropriate care and support transfer or discharge planning when needed.

The role requires an LPN license, a nursing degree, and 2–4 years of related experience. The position offers flexible work schedules including remote, hybrid, or on-site options with

Qualifications

Graduate from an Accredited School of Nursing or BSN with 2–4 years of related experience.
Clinical knowledge to analyze authorization requests and determine medical necessity.
LPN license required; Fidelis Plan requires a clinical healthcare degree with the appropriate license.

Responsibilities

Analyzes all prior authorization requests to determine medical necessity of service and level of care.
Provides recommendations to the medical team to promote quality and cost-effective care.
Coordinates with providers and interdepartmental teams to ensure timely reviews.
Educates providers and teams on utilization processes to improve the authorization workflow.

Skills

Nursing

Education

Bachelor's degree in Nursing

LPN license (State Licensure)

Job description

The role requires an LPN license, a nursing degree, and 2–4 years of related experience. The position offers flexible work schedules including remote, hybrid, or on-site options with

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