This position involves performing clinical reviews to resolve and process appeals by analyzing medical records and clinical data in accordance with established guidelines.
Centene Management Company LLC is a diversified national organization dedicated to transforming the health of communities by providing high-quality healthcare solutions to its 28 million members. With a focus on building strong partnerships between health plans and provider networks, Centene emphasizes optimal performance in care delivery, quality improvement, and cost utilization. The company values diversity and offers a comprehensive benefits package, including competitive pay, flexible work arrangements, and support for employee development. Centene is committed to helping individuals and families live healthier lives through innovative programs and a wide range of health solutions.
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Jobs from Centene Management Company:
Utilization Review Clinician - Behavioral Health
Manager, Actuarial Services
Director, Vendor Management Hub
Behavioral Health Service Coordinator
Senior Clinical Review Nurse - Correspondence
Centene Management Company LLC is a diversified national organization dedicated to transforming the health of communities by providing high-quality healthcare solutions to its 28 million members. With a focus on building strong partnerships between health plans and provider networks, Centene emphasizes optimal performance in care delivery, quality improvement, and cost utilization. The company values diversity and offers a comprehensive benefits package, including competitive pay, flexible work arrangements, and support for employee development. Centene is committed to helping individuals and families live healthier lives through innovative programs and a wide range of health solutions.
Share This Job!
Save This Job!
Jobs from Centene Management Company:
Utilization Review Clinician - Behavioral Health
Manager, Actuarial Services
Director, Vendor Management Hub
Behavioral Health Service Coordinator
Senior Clinical Review Nurse - Correspondence
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Morgan Stephens
Join a Managed Care Organization as a Care Review Clinician, responsible for clinical reviews and authorizations in a remote role.
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Molina Talent Acquisition
The Clinical Appeals Nurse (RN) is responsible for reviewing medical claims and ensuring compliance with clinical standards in a remote capacity.
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Ensemble RCM
Join Ensemble Health Partners as an RN Clinical Appeals Specialist, managing claims denials and contributing to a culture of healthcare innovation.
The Clinical Appeals Specialist RN reviews and appeals clinical claim denials, utilizing expertise to ensure medical necessity compliance.
The Clinical Appeals Specialist manages medical necessity denials and prepares appeals in a remote full-time position.