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Prior Authorization Nurse I

Company: Centene Corporation
Location: Orlando
Posted on: November 23, 2021

Job Description:

You could be the one who changes everything for our 25 million members as a Prior Authorization Nurse I on the Clinical team. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national Fortune 24 and rapidly growing organization, exceptional talent fuels our mission. Do you thrive in a supportive, result-oriented community and are committed to the relentless pursuit of continuous growth? As part of our clinical group, the member-focused care you deliver will make a difference and change the face of healthcare for Florida. Are you ready to make an impact? As a Prior Authorization Nurse I, you will: 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 systems Benefits & Perks: * Flexible work solutions, including work from home and telecommuting * Paid Time Off including paid holidays * Health insurance coverage for you and dependents * 401(k) and stock purchase plans * Tuition reimbursement and best-in-class training and development * In-person and virtual training following State and Community guidelines Requirements: * 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. About Centene: We are an industry leader with a local focus and a global vision: * We are a diversified, multi-national, inclusive healthcare company delivering relevant, technology-driven solutions at the global, national, and local levels * Listed on Fortune magazine's World's Most Admired Companies List for 2nd consecutive year * National footprint across all 50 states, serving 1 in 15 individuals in the U.S. * Recognized as one of the Best Places to Work by the Human Rights Campaign Foundation 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.

Keywords: Centene Corporation, Orlando , Prior Authorization Nurse I, Healthcare , Orlando, Florida

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