Clinical Review Nurse - Prior Authorization

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. Work Location: This is a fully remote role. Candidates must hold active New York State Registered Nurse (RN) licensure and be willing to work Eastern Time (ET/EST) hours. Licensure Requirement: Active and unrestricted New York State Registered Nurse (RN) licensure is required for consideration. Schedule: This position follows a Monday–Friday schedule from 8:30 AM to 5:00 PM Eastern Time (ET/EST) , with a one‑hour assigned lunch break. Candidates must be able to work during these hours. 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. Education/Experience: Requires Graduate from an Accredited School of Nursing or Bac...