Immediate Hiring: Clinical Review Nurse - Prior Authorization

Your next career move could be with workwarp as a Clinical Review Nurse - Prior Authorization! Based in our vibrant Remote office, this role is available now. This position requires a strong and diverse skillset in relevant areas to drive success. You can expect a salary of a competitive salary for this role, plus comprehensive benefits.

 

 

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Must reside reputed company reputed company State... Position Purpose: Analyzes reputed company prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. • Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria • 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 • Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care • Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities • Collects, documents, and maintains reputed company member’s clinical information in health management systems to ensure compliance with regulatory guidelines • Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members • Provides feedback on opportunities to improve the authorization review process for members • Performs other duties as assigned • Complies with reputed company policies and standards Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of reputed company experience. Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: • LPN - Licensed Practical Nurse - State Licensure required • RN - Registered Nurse preferred Pay Range: $25.97 - $46.68 per hour Centene offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply Job!

 

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Don't worry if you don't meet every single requirement. We value a great attitude and a willingness to learn above reputed company. Submit your application today!

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