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.
Must have a New York State license or identification card.
Position Purpose: The Utilization Review (UM) Clinician (LPN) performs clinical reviews to assess medical necessity of a broad range of outpatient and inpatient services, while maintaining compliance with all regulatory requirements.
- Interfaces with medical directors, and both internal and external stakeholders, with regard to coverage for services, contract benefits and alternate resources available.
- This position interfaces frequently with treating providers in the gathering of clinical information and may also provide education on the medical review process.
- The Utilization Management clinician (LPN) makes coverage decisions based on specific criteria including Milliman.
- Frequently collaborates with Fidelis medical directors in determining coverage of requested services.
- Interacts with members to assist with accessing appropriate resources for requested services.
Education/Experience: Associate’s degree preferred; Bachelors Degree preferred. 1-3 years Utilization Review experience preferred. Managed care experience preferred
License/Certification: NYS LPN License RequiredPay Range: $25.97 – $46.68 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a 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. Total compensation may also include additional forms of incentives.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act