Vacancy 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.
**RN Strongly Preferred - Compact RN License Required**
**100% Remote**
**Business Hours are 8a - 6p CST. Shifts include one day on the weekend**
**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.
+ Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal
+ Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQ...
**RN Strongly Preferred - Compact RN License Required**
**100% Remote**
**Business Hours are 8a - 6p CST. Shifts include one day on the weekend**
**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.
+ Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal
+ Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQ...
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