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Prior Authorization Nurse I/Remote/FL/Bonus Eligible

Company: Centene Corporation
Location: Fort Lauderdale
Posted on: January 13, 2022

Job Description:

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.+ Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations+ Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings+ Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care+ Educate providers on utilization and medical management processes+ Provide clinical knowledge and act as a clinical resource to non-clinical team staff+ Enter and maintain pertinent clinical information in various medical management systemsOur Comprehensive Benefits Package:Flexible work solutions including remote options, hybrid work schedules and dress flexibilityCompetitive payPaid Time Off including paid holidaysHealth insurance coverage for you and dependents401(k) and stock purchase plansTuition reimbursement and best-in-class training and development Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred.Licenses/Certifications: Current State LPN/LVN or RN license._Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law._ TITLE: Prior Authorization Nurse I/Remote/FL/Bonus Eligible LOCATION: Plantation, Florida REQNUMBER: 1292544

Keywords: Centene Corporation, Fort Lauderdale , Prior Authorization Nurse I/Remote/FL/Bonus Eligible, Healthcare , Fort Lauderdale, Florida

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