View All Jobs 5220
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
9 months ago
Centene
Transforming the health of the communities we serve, one person at a time
Job is no longer active
28 Similar Jobs at Centene
✨ 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
⚡ Requirements
- 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
Remote Clinical Review Nurse – Prior Authorization, Multiple Locations
Various
$25.00 - $44.85 per hour
Remote
Job is no longer active
About Centene
Transforming the health of the communities we serve, one person at a time