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Senior Clinical Review Nurse - Correspondence - Remote

Posted 2 days ago
All others
Full Time
USA
30.00 - 54.03/hour

Overview

As a Senior Clinical Review Nurse, you will play a crucial role in ensuring quality healthcare for our members by drafting correspondence and conducting clinical reviews in accordance with NCQA standards.

In Short

  • Drafts correspondence letters and supports team needs.
  • Reviews clinical outcomes based on NCQA standards.
  • Identifies improvement opportunities with senior management.
  • Conducts clinical reviews and edits denial letters.
  • Audits correspondence for compliance with regulations.
  • Investigates denial claims and resolves issues.
  • Acts as a liaison for correspondence-related inquiries.
  • Monitors cases for timely resolution.
  • Provides education on utilization management trends.
  • Complies with all policies and standards.

Requirements

  • Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing.
  • 4 – 6 years of related experience required.
  • Expertise in Medicare and Medicaid regulations preferred.
  • Expertise in utilization management processes preferred.
  • RN or LPN state licensure required.

Benefits

  • Competitive pay and comprehensive benefits package.
  • Health insurance and 401K options.
  • Tuition reimbursement and paid time off.
  • Flexible work schedules including remote options.
  • Commitment to diversity and equal opportunity.
Centene Management Company logo

Centene Management Company

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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