Clinical Review Nurse - Prior Authorization

The Clinical Review Nurse - Prior Authorization analyzes prior authorization requests to determine medical necessity and appropriate levels of care. This remote position is ideal for nurses with experience in utilization management and a strong understanding of regulatory guidelines.

• Pay: $27.02 - $48.55 per hour
• Location: Remote, TX
• Schedule: Full Time

• Perform medical necessity and clinical reviews of authorization requests.
• Work with healthcare providers and authorization team for timely service reviews.
• Coordinate with healthcare providers and interdepartmental teams to assess medical necessity.
• Escalate prior authorization requests to Medical Directors as needed.
• Assist with service authorization requests for member transfers or discharges.
• Collect, document, and maintain member clinical information in health management systems.
• Educate providers and interdepartmental teams on utilization processes.
• Provide feedback on opportunities to improve the authorization review process.
• Perform other duties as assigned.
• Comply with all policies and standards.

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing

• 2 – 4 years of related experience

• RN license required

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules

Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, supporting individuals, families, and communities through meaningful challenges.