Clinical Review Clinician - Appeals at Centene

This role is ideal for licensed clinical professionals (RN, LPN, LCSW, or similar) with 2–4 years of experience in clinical review or medical management. While several license types are accepted, the team is specifically seeking those with a background in nursing and utilization management to handle complex medical necessity determinations. This is a **fully remote** position offering significant flexibility and a comprehensive benefits package, including a 401k, stock purchase plan, and tuition reimbursement. It provides a stable, process-driven environment where you can apply clinical expertise to the administrative side of healthcare, ensuring compliance with State, Federal, and NCQA standards. **You might be a good fit if you:** * Hold an active clinical license (RN highly preferred, but LPN, LCSW, or LPC are eligible). * Have a strong understanding of Medicare, Medicaid, and NCQA regulations. * Enjoy investigative work, such as reviewing medical records to analyze the basis for appeals. * Excel at communicating complex clinical decisions to both members and providers.