Prior Authorization Nurse I

Centene

Job Details

Location: Lenexa, Johnson County, Kansas, USA Posted: Dec 24, 2019

Job Description

Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.

Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations

Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings

Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care

Educate providers on utilization and medical management processes

Provide clinical knowledge and act as a clinical resource to non-clinical team staff

Enter and maintain pertinent clinical information in various medical management systems

About Centene

Centene is a multi-line health care enterprise offering Medicaid managed care and specialty services.

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