Centene Management Company LLC is hiring a Clinical Review Nurse - Prior Authorization

You could be the one who transforms healthcare for 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a forward-thinking national organization offering a fresh take on workplace flexibility and competitive benefits. Qualified candidates must hold an active RN license in California, Mississippi, Texas, or Oregon. Position Purpose: Dive deep into prior authorization requests to determine medical necessity and appropriate care levels, aligning with national standards, contractual requirements, and individual member benefits. Your recommendations will drive quality and cost-effectiveness in medical care. • Perform medical necessity and clinical reviews of authorization requests, ensuring care appropriateness per regulatory guidelines • Collaborate with healthcare providers and authorization teams to guarantee timely service reviews • Coordinate with healthcare providers and internal teams to assess member care necessity • Escalate complex prior authorization requests to Medical Directors when needed • Support seamless member transfer and discharge plans across care levels and facilities • Meticulously collect, document, and maintain clinical information in health management systems • Provide education to providers and teams on utilization processes for high-quality, cost-effective care • Offer constructive feedback to improve authorization review processes • Perform additional duties as assigned • Consistently comply with all organizational policies and standards Education/Experience: Requires graduation from an Accredited School of Nursing or Bachelor's in Nursing with 2-4 years related experience. Strong clinical knowledge in analyzing authorization requests and determining medical service necessity is highly valued. Familiarity with Medicare and Medicaid regulations and utilization management processes preferred. License/Certification: • Oregon RN licensure required OR • California RN licensure required OR • Texas RN licensure required OR • Mississippi RN licensure required Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work (remote, hybrid, field, or office). Actual pay will be adjusted based on individual skills, experience, education, and job-related factors. Total compensation may include additional incentive forms. Benefits subject to program eligibility. Centene is an equal opportunity employer committed to diversity, valuing the unique ways we differ. All qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and California Fair Chance Act.