Clinical Review Clinician_Appeals

Job description

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 benefits including a fresh perspective on workplace flexibility. This position is seeking LVN, LPN, or RN's with Medicare Appeals Experience. Hours are Wednesday - Sunday 8am to 5pm. (hours can accommodate the time zone you reside) Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. This position is seeking LVN, LPN, or RN's with Medicare Appeals Experience. Hours are Wednesday - Sunday 8am to 5pm. (hours can accommodate the time zone you reside) Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. This position is seeking LVN, LPN, or RN...