RN Clinical Appeals Coordinator job opportunity at Centene Corporation.

Home Jobs In United States Of America Tag: Job RN Clinical Appeals Coordinator position at Centene Corporation


DatePosted 3 Days Ago bot
Centene Corporation RN Clinical Appeals Coordinator
Experience: 4-years
Pattern: Remote
Country:
apply Apply Now
Salary:
Status:

Job

Copy Link Report
degreeHigh School (S.S.C.E)
loacation Remote-LA, United States Of America
loacation Remote-LA....United States Of America

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.   Applicants must reside in LA and have RN licensure Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements. Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested Prepare reviews for cases that did not meet criteria Gather, analyze and report verbal and written information regarding member and provider clinical appeals, including information follow up Prepare response letters for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. Maintain files and logs for all appeals Coordinate with Medical Director(s) to clarify medical determinations or clinical rationale Maintain current knowledge of NCQA and State regulations Coordinate Fair Hearings with various internal departments and agencies Performs other duties as assigned Complies with all policies and standards Applicants must reside in LA and have RN licensure Education/Experience: 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. Managed care or utilization review experience preferred. License/Certification: LPN, LVN, or RN license. Corporate & Louisiana Healthcare Connections Requirements: Current state RN, LPN, or LVN, LPC, LCSW, or Psy.D license. Pay Range: $33.71 - $60.67 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law , including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Other Ai Matches

remote-jobserver Remote
Care Manager Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Quality Practice Advisor Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Quality Care Member Advocate Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Care Coordinator II Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Senior Compliance Administrator - DSNP Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Data Security Engineer II Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Senior Detection Engineer Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Behavioral Health Utilization Review Clinician Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Remote Medical Director Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Director, Quality Improvement Applicants are expected to have a solid experience in handling Quality Improvement related tasks
remote-jobserver Remote
Quality Care Member Advocate Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Senior Compliance Analyst - Mental Health Parity Applicants are expected to have a solid experience in handling Job related tasks
Chief Medical Officer, Ohio Applicants are expected to have a solid experience in handling Ohio related tasks
remote-jobserver Remote
LTSS Service Care Coordinator Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Senior Director, Payment Integrity - Audit Programs Applicants are expected to have a solid experience in handling Payment Integrity - Audit Programs related tasks
remote-jobserver Remote
Contract Administrator II Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Senior LTSS Service Care Manager (RN) Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Care Manager Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Quality Practice Advisor Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Pharmacist Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Senior Applications Administrator - ServiceNow CMDB Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Behavioral Health Program Manager Applicants are expected to have a solid experience in handling Job related tasks
remote-jobserver Remote
Quality Practice Advisor Applicants are expected to have a solid experience in handling Job related tasks