Senior Rn Clinical Review Nurse - Prior Authorization

Centene

Base: $30.58 - $55.09 ph; bonus/equity: not specif...
Hybrid
Review complex prior authorization requests
Determine medical necessity of services
Collaborate with healthcare providers
Centene is seeking a Senior RN Clinical Review Nurse for its Medical Management/Health Services team, focusing on prior authorization requests to determine medical necessity and appropriate levels of care. The ideal candidate will possess a New York RN license, extensive nursing experience, and knowledge of Medicare and Medicaid regulations, with a strong emphasis on collaboration and process improvement

Job Summary

  • This position supports the Fidelis state plan and requires NY RN Licensure to review challenging prior authorization requests.
  • The role involves assessing complex authorization requests, collaborating with providers, and escalating cases to Medical Directors when necessary.
  • Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K, and flexible work schedules.

Matching Summary

Match Score: 85

Centene is seeking a Senior RN Clinical Review Nurse for its Medical Management/Health Services team, focusing on prior authorization requests to determine medical necessity and appropriate levels of care. The ideal candidate will possess a New York RN license, extensive nursing experience, and knowledge of Medicare and Medicaid regulations, with a strong emphasis on collaboration and process improvement.

Salary

Base: $30.58 - $55.09 per hour; Bonus/Equity: Not specified; Benefits: Health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off

Skills & Requirements

Must-have

  • Review complex prior authorization requests
  • Determine medical necessity of services
  • Collaborate with healthcare providers
  • Ensure timely discharge planning
  • Comply with regulatory guidelines

Nice-to-have

  • Provide education to providers on processes
  • Act as trainer to team members
  • Participate in interdepartmental projects
  • Promote quality and cost effectiveness

Key Requirements

  • Graduate from Accredited School of Nursing or Bachelor's degree in Nursing
  • 4-6 years of related experience
  • NY RN Licensure required
  • Strong knowledge of Medicare and Medicaid regulations preferred
  • Strong knowledge of utilization management processes preferred

Work Rights

Not specified

Tailored Resume

Cover Letter