Clinical Review Nurse
1 week ago
Clinical Review Nurse - Prior Authorization Join to apply for the Clinical Review Nurse - Prior Authorization role at Centene Corporation Position Purpose Analyzes all 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. Responsibilities 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 all 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 all policies and standards. Education & Experience Requires Graduate from an Accredited School of Nursing or Bachelors degree in Nursing and 24 years of related 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. Pay & Benefits Pay Range $26.50 $47.59 per hour. Centene offers a comprehensive benefits package including health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work options. Equal Opportunity Employer Centene is an equal opportunity employer committed to diversity and inclusion. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act. #J-18808-Ljbffr
-
Clinical Review Nurse
4 weeks ago
Washington, United States Centene Corporation Full timeClinical Review Nurse – Concurrent Review As a member of our Medical Management/Health Services team, you will play a vital role in ensuring the highest quality care for our 28 million members. You will conduct concurrent reviews, evaluate medical necessity, and collaborate with providers and leaders to support appropriate care planning and discharge...
-
Clinical Review Nurse
1 week ago
Washington, United States Centene Corporation Full timeClinical Review Nurse - Concurrent Review Join to apply for the Clinical Review Nurse - Concurrent Review role at Centene Corporation. Overview 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 diversified, national organization offering competitive...
-
Clinical Review Nurse
1 week ago
Washington, IN, United States Centene Corporation Full timeClinical Review Nurse - Concurrent Review Join to apply for the Clinical Review Nurse - Concurrent Review role at Centene Corporation. Overview 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 diversified, national organization offering competitive...
-
Clinical Review Nurse
1 week ago
Washington, IN, United States Centene Corporation Full timeClinical Review Nurse - Concurrent Review Join to apply for the Clinical Review Nurse - Concurrent Review role at Centene Corporation. Overview 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 diversified, national organization offering competitive...
-
Clinical Review Nurse
1 week ago
Washington, IN, United States Centene Corporation Full timeClinical Review Nurse - Concurrent Review Join to apply for the Clinical Review Nurse - Concurrent Review role at Centene Corporation. Overview 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 diversified, national organization offering competitive...
-
Clinical Review Nurse
1 week ago
Washington, IN, United States Centene Corporation Full timeClinical Review Nurse - Concurrent Review Join to apply for the Clinical Review Nurse - Concurrent Review role at Centene Corporation. Overview 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 diversified, national organization offering competitive...
-
Clinical Review Nurse
1 week ago
Washington, IN, United States Centene Corporation Full timeClinical Review Nurse - Concurrent Review Join to apply for the Clinical Review Nurse - Concurrent Review role at Centene Corporation. Overview 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 diversified, national organization offering competitive...
-
Clinical Review Nurse
1 week ago
Washington, IN, United States Centene Corporation Full timeClinical Review Nurse - Concurrent Review Join to apply for the Clinical Review Nurse - Concurrent Review role at Centene Corporation. Overview 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 diversified, national organization offering competitive...
-
Clinical Reviewer Lead
4 weeks ago
Washington, United States Comagine Health Full timevision insurance, parental leave, paid time off, remote work United States, D.C., Washington About Company: About Company: Why Comagine Health? Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years. We are leaders in assisting front-line...
-
Clinical Reviewer, Nurse
1 week ago
Washington, DC, United States Evolent Full timeYour Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved...
