Centene Management Company LLC is seeking a Medical Review Specialist III to support our peer-to-peer (P2P) authorization processes. You will be responsible for scheduling clinical discussions between Medical Directors and providers and serving as a key point of contact.
What You'll Do
- Manage and review Medical Director workflow queues in the medical management system, adjusting based on escalations and scheduling needs.
- Schedule peer-to-peer (P2P) discussions between Medical Directors and providers regarding clinical services and prior authorization approvals.
- Manage turn-around times to ensure P2P reviews are conducted within required regulatory and policy timeframes.
- Develop in-depth knowledge of P2P processes, best practices, and internal policies.
- Serve as front-line support for communications with providers and vendors.
- Provide support for communications between clinical staff, providers, and Medical Directors.
- Work with different teams to identify and implement process improvements and efficiencies within the P2P process.
- Perform other assigned duties and comply with all policies and standards.
What We're Looking For
- A High School diploma or GED.
- 2 - 4 years of related experience.
Nice to Have
- Strong knowledge of medical terminology and practices.
Benefits & Compensation
- Hourly compensation: $22.50 - $38.02
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field, or office work schedules
Work Mode
This role offers a flexible approach to work, including remote, hybrid, field, or office work schedules. The position is located in the United States.
Centene is an equal opportunity employer that is committed to diversity. 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.
