Clinical Review Clinician - Appeals
Remote-TXremote$56K – $101K
Posted today · via Workday
About this role
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. NOTE: Candidates must be fully licensed with one of the approved license/certifications listed below upon the submission of the Centene application . Required Work Schedule: 8:00 am - 5:00 pm (CST) and a Rotating On-Call schedule Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.…
What we'd score you on
reqspace match rubricFive dimensions, recruiter-grade. Upload your resume and we'll generate a written explanation of where you fit and where the gaps are.
1
Skills match
For this role: teams, zoom
2
Level fit
We check your title trajectory against the seniority signal of the role.
3
Domain experience
Your work in the role's domain matters more than your years total. We weight recent and direct experience.
4
Recency
A skill you used last quarter weighs more than one from five years ago. We grade on recency, not lifetime.
5
Location fit
This role is remote-eligible — we factor in your stated location and time-zone overlap.
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