[Hiring] Medical Review Specialist III @Centene Corporation

Role Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

• Supports peer-to-peer (P2P) processes, including scheduling P2P between Medical Directors and providers according to internal policies and requirements.
• 100% Remote position. Prefer candidates to reside in EST or CST time zones. Working hours are Monday - Friday 8-5pm EST OR 9-6pm EST.
• Manages and reviews Medical Director’s workflow queue in the medical management system and adjusts workflows as needed based on escalations and scheduling.
• Schedules peer-to-peer (P2P) between Medical Directors and providers to discuss clinical services including the approval of a prior authorization.
• Manages turn-around times for P2P authorizations to ensure P2P are conducted within a timely manner in accordance with regulations and policies.
• Develops in-depth knowledge of P2P process, best practices, and internal policies and requirements.
• Serves as front-line support in communicating with providers and/or vendors.
• Provides support with all communications between clinical staff, providers, and Medical Directors.
• Works with different teams to identify process improvements and efficiencies within the P2P process.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Requires a High School diploma or GED.
• Requires 2 - 4 years of related experience.
• Strong knowledge of medical terminology and practices preferred.

Requirements

• 100% Remote position. Prefer candidates to reside in EST or CST time zones. Working hours are Monday - Friday 8-5pm EST OR 9-6pm EST.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.