Overview

Imagine being the person who truly transforms healthcare for millions of people. At Centene Corporation, our clinical professionals on the Medical Management and Health Services team do just that every single day. We are looking for a dedicated Clinical Review Nurse who wants to make a real impact while enjoying the freedom of a fully remote setup available worldwide. If you love helping patients get the right care at the right time and you operate on Pacific Standard Time hours, you might just be the exact fit we need.

Key Responsibilities

Analyze incoming prior authorization requests to determine medical necessity and the appropriate level of care.
Partner with healthcare providers and authorization teams to ensure timely reviews and seamless care delivery.
Coordinate across interdepartmental teams to evaluate the clinical appropriateness of treatments and services.
Escalate complex prior authorization requests when specialized medical review is required.

Requirements

Active California Registered Nurse license is required.
Ability to work consistent Pacific Standard Time hours in a remote environment.
Strong clinical background with a solid understanding of medical necessity criteria and regulatory guidelines.
Exceptional communication skills for collaborating with providers and internal teams alike.

What You'll Gain

Joining Centene means stepping into a supportive culture that values your expertise. You will enjoy competitive benefits, a fresh perspective on workplace flexibility, and the chance to shape the future of healthcare for nearly 28 million members from the comfort of your own home, no matter where you live in the world.