Clinical Review Nurse – Prior Authorization

🔥 0 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Analyze prior authorization requests to determine medical necessity and appropriate level of care • Perform medical necessity and clinical reviews of authorization requests according to regulatory guidelines and criteria • Work with healthcare providers and authorization teams to ensure timely review and authorized care • Coordinate with healthcare providers and interdepartmental teams to assess members’ medical necessity of care • Escalate prior authorization requests to Medical Directors when appropriate • Assist with service authorization requests for member transfers or discharge plans • Collect, document, and maintain members’ clinical information in health management systems • Educate providers and interdepartmental teams on utilization processes • Provide feedback on opportunities to improve the authorization review process • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Applicants must reside in Oklahoma • Must be a licensed LPN or RN • Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing • 2–4 years of related experience • Experience with InterQual, utilization management, and Medicaid • Comfortable working in a metric-driven environment • Technologically savvy • Excellent communication, customer service, and time-management skills • Availability for weekend and holiday rotation • Work schedule availability from 8:00 AM to 5:00 PM • Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred • Knowledge of Medicare and Medicaid regulations preferred • Knowledge of utilization management processes preferred • LPN — Licensed Practical Nurse — State Licensure required • RN — Registered Nurse — State Licensure

🏖️ Benefits

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity