Base: $27.02 - $48.55 ph; bonus/equity: not specif...
Hybrid
Medicare appeals experience required
Wednesday through sunday work schedule
Review medical records for necessity
Centene is seeking a Clinical Review Clinician with Medicare Appeals experience to join their Medical Management/Health Services team. The role requires an LVN, LPN, or RN to perform clinical reviews for appeals, ensuring compliance with policies and standards
Job Summary
This role involves performing clinical reviews to resolve and process appeals by analyzing medical records against NCQA standards.
The position offers a flexible work arrangement with hours from Wednesday to Sunday accommodating various time zones.
Centene provides a comprehensive benefits package including health insurance, 401K, stock purchase plans, and tuition reimbursement.
Matching Summary
Match Score: 85
Centene is seeking a Clinical Review Clinician with Medicare Appeals experience to join their Medical Management/Health Services team. The role requires an LVN, LPN, or RN to perform clinical reviews for appeals, ensuring compliance with policies and standards.
Salary
Base: $27.02 - $48.55 per hour; Bonus/Equity: Not specified; Benefits: Health insurance, 401K, stock purchase plans, tuition reimbursement, PTO
Skills & Requirements
Must-have
Medicare Appeals Experience required
Wednesday through Sunday work schedule
Review medical records for necessity
Nice-to-have
Knowledge of NCQA standards preferred
Understanding of utilization management processes
Experience with interdepartmental collaboration
Key Requirements
Graduate from Accredited School of Nursing or Bachelor's degree in Nursing
2-4 years of related experience
State Licensure as LPN, LVN, RN, LCSW, LMHC, LPC, LMFT, or Psychologist