Senior Clinical Review Nurse - Remote Authorization Expert

Centene Corporation; United States; À distance; USD 42 705 - 75 768; Plein temps

Avantages offerts par ce poste

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements (remote/hy-

Résumé du poste

Centene Corporation is seeking a clinical professional on our Medical Management/Health Services team to review prior authorization requests and determine medical necessity for NY members. Requires NY licensure as RN.

The role emphasizes collaboration with providers, other teams, and learning the authorization process to promote quality and cost-effective care, with flexible remote/hybrid/work options.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing.
• NY State Licensure as RN.
• 4–6 years of related experience in clinical reviews or utilization management.

Responsabilités

• Reviews medical necessity and clinical reviews of authorization requests.
• Collaborates with providers and authorization team for timely reviews.
• Escalates requests to Medical Directors when appropriate.
• Manages authorizations for transfer or discharge planning.
• Suggests improvements to the authorization review process.
• Coordinates with care management and utilization teams.
• Keeps health management systems compliant with regulations.
• Educates providers on utilization processes.
• Owns and trains on the prior authorization process.
• Performs other duties and adheres to policies.

Connaissances

Clinical reviews

Utilization management

Interprofessional collaboration

Education to providers

Formation

Bachelor's in Nursing or Nursing degree

Outils

EMR systems

Description du poste

Centene Corporation is seeking a clinical professional on our Medical Management/Health Services team to review prior authorization requests and determine medical necessity for NY members. Requires NY licensure as RN.

The role emphasizes collaboration with providers, other teams, and learning the authorization process to promote quality and cost-effective care, with flexible remote/hybrid/work options.