Centene Management Company LLC is looking for a Medical Review Specialist III to support our clinical operations. You will be a key player in managing peer-to-peer review processes and ensuring timely communication and workflow between our Medical Directors and external providers.
What You'll Do
- Support peer-to-peer processes, including scheduling between Medical Directors and providers according to internal policies.
- Manage and review the Medical Director’s workflow queue in the medical management system, adjusting workflows based on escalations and scheduling needs.
- Schedule peer-to-peer discussions between Medical Directors and providers to review clinical services and prior authorization approvals.
- Manage turn-around times for peer-to-peer authorizations to ensure timely completion in accordance with regulations and policies.
- Develop in-depth knowledge of the peer-to-peer process, best practices, and internal requirements.
- Serve as front-line support in communicating with providers and vendors.
- Provide support for all communications between clinical staff, providers, and Medical Directors.
- Work with different teams to identify process improvements and efficiencies within the peer-to-peer process.
- Perform other duties as assigned and comply with all policies and standards.
What We're Looking For
- High School diploma or GED
- 2 - 4 years of related experience
Nice to Have
- Strong knowledge of medical terminology and practices
Benefits & Compensation
- Compensation: $22.50 - $38.02 per hour
- 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
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.
