Clinical Review Nurse Specialist

3 weeks ago


Latham, Kansas, United States Centene Corporation Full time

Prior Authorization Reviewer Role

As a Prior Authorization Reviewer with Centene Corporation, you will play a critical role in ensuring that our members receive the necessary care and services. Your primary responsibility will be to analyze 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.

Key Responsibilities:

  • Analyze prior authorization requests to determine medical necessity of service and appropriate level of care
  • Review and evaluate requests in accordance with national standards, contractual requirements, and a member's benefit coverage
  • Provide recommendations to the appropriate stakeholders, including the Authorization, Clinical, Nurse, Medical Director, and Healthcare teams

Requirements:

  • Strong analytical and problem-solving skills
  • Excellent communication and interpersonal skills
  • Ability to work in a fast-paced environment and meet deadlines


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