Clinical Review Clinician - Appeals
Centene
Texas, Tennessee, Kansas, Florida, Iowa, Arkansas, Missouri, Oklahoma
Workplace: RemoteFull timeUSD 27.02 - 48.55 hourlyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 2-4 yearsEducation: bachelorsSkills: ["Communication","Research","Analysis","Process improvement","Collaboration"]Conduct clinical reviews for member appeals on the Medical Management/Health Services team, determining medical necessity by analyzing medical records and clinical data against policies, guidelines, and NCQA standards. Prepare case reviews for Medical Directors, ensure timely appeal processing and responses, and communicate with members, providers, facilities, and internal teams. Improve consistency and efficiency of appeals resolutions through process and best-practice collaboration.
