• Job Description

  Req#: 1606029
  Employer Industry: Managed Care Services
  
  Why Consider this Job Opportunity:
  - Salary up to $59.47 per hour
  - Comprehensive benefits package including health insurance, 401K and stock purchase plans, tuition reimbursement, and paid time off
  - Flexible work arrangements available, including remote, hybrid, field, or office work schedules
  - Opportunity to make a significant impact on member care and clinical outcomes
  - Supportive work environment that values diversity and inclusion
  - Potential for additional incentives based on performance and job-related factors
  
  What to Expect (Job Responsibilities):
  - Act as the liaison for statewide appeals, fair hearings, and external review organizations
  - Review clinical information for appeals to determine medical necessity of requested services
  - Prepare response letters for member and provider clinical appeals, ensuring compliance with State and NCQA standards
  - Maintain files and logs for all appeals and coordinate with Medical Directors for clarification on medical determinations
  - Stay updated on NCQA and State regulations to ensure compliance in all activities
  
  What is Required (Qualifications):
  - RN with 4+ years of clinical nursing and/or case management experience, or LPN/LVN with 5+ years of clinical nursing or case management experience
  - Current RN, LPN, or LVN license
  - Experience in managed care or utilization review preferred
  - Knowledge of NCQA and State regulations
  - Ability to analyze and report clinical information effectively
  
  How to Stand Out (Preferred Qualifications):
  - Experience with utilization review and case management in a managed care setting
  - Master’s degree in a specialty therapy area or equivalent experience
  - 3+ years of experience providing therapy services in healthcare or home health settings
  - Current state license in Physical Therapy, Occupational Therapy, or Speech-Language Therapy
  - Active Certificate of Clinical Competence from the American Speech-Language-Hearing Association for Speech-Language Therapists
  
  #ManagedCare #ClinicalNursing #HealthcareCareers #RemoteWork #DiversityAndInclusion
  
  "We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
  We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."

• About the company

  Centene Corporation is a publicly traded managed care company based in St.

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