ChesterfieldRecruiter Since 2001
the smart solution for Chesterfield jobs

Prior Authorization Nurse I

Company: Centene
Location: Chesterfield
Posted on: November 5, 2019

Job Description:

Prior Authorization Nurse I 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 Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current State LPN/LVN or RN license. For New Hampshire Healthy Families: Candidates with active nursing licenses in good standing in other states than NH, must obtain the NH equivalent within 90 days of hire. : Active driver's license in good standing preferred. For North Carolina only: In addition, these individuals will conduct utilization management activities, including but not limited to prior authorization, concurrent review and retrospective review. Must reside in North Carolina, and be NC licensed nurse and/or licensed behavioral health professional in good standing. 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. Clinical & Nursing USA-Missouri-Chesterfield Home State Health Plan Full-time

Keywords: Centene, Chesterfield , Prior Authorization Nurse I, Healthcare , Chesterfield, Missouri

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


Travel Registered Nurse RN Pediatrics
Description: Pediatric Nurses work with patients from infancy to young adulthood,
Company: OneStaff Medical
Location: Saint Louis
Posted on: 11/13/2019

Registered Nurse - RN - PSYC (Contract)
Description: Psychiatric Registered Nurse Psych RN Travel Contract Open in Bridgeton, MO. br br Psychiatric Registered Nurse Psych RN Details: br --- Experienced Psychiatric
Company: Favorite Healthcare Staffing
Location: Saint Louis
Posted on: 11/13/2019

Travel Nurse - Step Down RN - St Louis, MO
Description: Travel Step Down Registered Nurse RN br Earn 1,600- 1,700 weekly when you start your next travel opportunity with this great Registered Nurse RN position in St. Louis, MO. br Job Details br (more...)
Company: General Healthcare Resources - Travel Nursing
Location: Saint Louis
Posted on: 11/13/2019


Travel Nurse - Onclgy RN - St Louis, MO
Description: Travel Oncology Registered Nurse RN br Start your next travel opportunity with this great Registered Nurse RN position in St.Louis, MO br Job Details br ul br li 1333/week take home pay (more...)
Company: General Healthcare Resources - Travel Nursing
Location: Saint Louis
Posted on: 11/13/2019

Travel Nurse RN - Psychiatric - $1,632 per week
Description: NurseFly Travel Nursing with trustaff is seeking a psychiatric travel nurse for a travel nursing job in Saint Louis, Missouri: br br br ul br li Specialty: Psychiatric br li Discipline: (more...)
Company: NurseFly Travel Nursing
Location: Saint Louis
Posted on: 11/13/2019

Child & Adolescent Psychiatrist (Physician #)
Description: PERMANENT FULL-TIME CHILD AND ADOLESCENT PSYCHIATRIST NEEDED A premier provider of behavioral
Company: FCSpsy
Location: Saint Louis
Posted on: 11/13/2019

Labor/Delivery
Description: State License: MO Certifications: Hospital in St. Louis, MO is looking for an experienced Registered Nurse for a travel contract. If you have experience and
Company: Magnet Medical
Location: Saint Louis
Posted on: 11/13/2019

Family Practice Physician (Physician #)
Description: Family Practice Physician Our Client is a growing healthcare organization based in St. Louis, MO that offers its employees full benefits, work/life balance and relocation assistance. The Company:
Company: Integrity Placement Group
Location: Saint Louis
Posted on: 11/13/2019

Nurse Practitione or PA - Pediatric Emergency (CHNW))
Description: This position is full-time and works approximately -40 hours per week. This position will primarily work the busy hours of -4pm-12pm during flu season. This is a 5 day, 8 hour shift full time position (more...)
Company: Washington University School of Medicine
Location: Saint Louis
Posted on: 11/13/2019

Imaging - CT Tech
Description: Travel CT Tech / CAT Technician br br As one of the largest and most recognized providers of healthcare professionals, Cross Country Allied has exciting Travel CT Tech opportunities you want and the (more...)
Company: Cross Country Allied
Location: Saint Louis
Posted on: 11/13/2019

Log In or Create An Account

Get the latest Missouri jobs by following @recnetMO on Twitter!

Chesterfield RSS job feeds