Centene Corporation
Clinician
$26.50-47.59 / hour
California
Full-Time
Remote
Actively Hiring
JobLeap AI Summary
Conduct clinical reviews to support healthcare appeals, utilizing your nursing background to ensure medical necessity and regulatory compliance. This flexible, full-time role is ideal for RNs with provider appeals experience.
Remote flexibility options
Competitive pay and benefits
California RN license required
Provider appeals experience valued
Full-time weekday schedule
Diverse, inclusive organization
About the job
Join a national healthcare organization in a clinical review role, performing appeals and medical necessity assessments for healthcare services. This position, open to candidates with a California RN license, offers flexible work arrangements and competitive benefits.
Key Responsibilities
- Conduct case reviews for medical appeals
- Research policy criteria and analyze appeals
- Ensure timely review and communication per standards
- Work collaboratively to improve processes and quality
- Generate reporting for internal stakeholders
- Maintain compliance with state, federal, and NCQA regulations
Qualifications
- Valid California RN license required
- Graduate of an accredited nursing school or Bachelor's in Nursing
- 2-4 years of related experience
- Knowledge of NCQA, Medicare, and Medicaid preferred
- Experience in utilization management or provider appeals preferred
Schedule & Compensation
- Monday–Friday, 8–5 PM PST
- Pay range: $26.50–$47.59 per hour
- Full suite of benefits, 401k, PTO, and tuition reimbursement
- Remote/hybrid/field/office options
Diversity & Inclusion
- Employer values diversity and provides equal opportunities for all
About Centene Corporation
Healthcare · 10,000+
Centene Corporation is a leading American healthcare enterprise specializing in government-sponsored and commercial healthcare programs. Founded in 1984 and headquartered in St. Louis, Missouri, Centene offers a wide range of services, including Medicaid, Medicare, and Health Insurance Marketplace plans. With over 60,000 employees, the company is committed to providing accessible, high-quality, and culturally sensitive healthcare to its members across all 50 states.