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Remote Clinical Review Nurse – Prior Authorization, Multiple Locations

Improve the prior authorization review process to enhance quality and cost-effective medical care.
Various
Mid-Level
$25.00 - $44.85 per hour
2 weeks ago
Centene

Centene

Transforming the health of the communities we serve, one person at a time

✨ About The Role

- Analyze all prior authorization requests to determine medical necessity of service and appropriate level of care - Provide recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care - Perform medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care - Work with healthcare providers and authorization team to ensure timely review of services and/or requests - Collect, document, and maintain all member’s clinical information in health management systems to ensure compliance with regulatory guidelines
- Requires a graduate from an Accredited School of Nursing or a Bachelor’s degree in Nursing with 2-4 years of related experience - Clinical knowledge and the ability to analyze authorization requests and determine medical necessity of service is preferred - Knowledge of Medicare and Medicaid regulations is preferred - Experience with utilization management processes is preferred - Must have a license as a Licensed Practical Nurse (LPN) with State Licensure
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Remote Clinical Review Nurse – Prior Authorization, Multiple Locations
Various
$25.00 - $44.85 per hour
Remote
About Centene
Transforming the health of the communities we serve, one person at a time