Clinical Review Nurse - Prior Authorization

About the Role

Emergency Medicine position at Centene in Anywhere. Join a team focused on quality patient care with excellent work-life balance.

Work-Life Balance Factors

Remote/telehealth

Key Responsibilities

• Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost
• Provides feedback on opportunities to improve the authorization review process for members
• Performs other duties as assigned
• Knowledge of utilization management processes preferred.
• Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care

Requirements

• Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.
• License/Certification:
• Licensed Practical Nurse
• State Licensure required
• Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience

Benefits & Compensation

• Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
• Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member
• Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines
• Pay Range: $27.02
• time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job