Manhattan, NY · On-site
$30.58 - $55.09/hr
Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. This position requires NY State Licensure as a RN, OT or PT ...
Manhattan, NY · On-site
$30.58 - $55.09/hr
Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. This position requires NY State Licensure as a RN, OT or PT ...
$15.90 - $23.40
2% of jobs
$23.40 - $30.91
3% of jobs
$30.91 - $38.42
13% of jobs
$42.18 is the 25th percentile. Wages below this are outliers.
$38.42 - $45.93
14% of jobs
$45.93 - $53.44
16% of jobs
The median wage is $54.69 / hr.
$53.44 - $60.95
13% of jobs
$60.95 - $68.46
14% of jobs
$68.84 is the 75th percentile. Wages above this are outliers.
$68.46 - $75.97
11% of jobs
$75.97 - $83.48
6% of jobs
$83.48 - $90.99
6% of jobs
$90.99 - $98.50
2% of jobs
$15
$57
$98
A Centene RN (Registered Nurse) job typically involves providing care management, health assessments, and coordination of services for members within Centene's healthcare plans. RNs in this role may work remotely or in the field, collaborating with providers and care teams to ensure patients receive appropriate medical services. Responsibilities often include reviewing clinical data, educating members on health conditions, and advocating for quality care. This position is ideal for nurses with case management, utilization review, or managed care experience.
As a Centene RN, your daily responsibilities typically include reviewing patient cases for medical necessity, coordinating care with healthcare providers, conducting telephonic patient assessments, and facilitating transitions of care. You'll work closely with providers, social workers, and other team members to help ensure members receive appropriate, cost-effective care aligned with Centene’s policies and guidelines. The role involves significant documentation and communication using healthcare management software. Expect a balance of independent work and collaboration within a supportive team environment. This position is ideal for nurses who enjoy leveraging clinical expertise in a case management or care coordination setting.
A Centene RN requires current RN licensure, solid clinical judgment, and experience in case management or utilization review. Familiarity with healthcare management systems, electronic health records (EHRs), and case management platforms like InterQual or Milliman is often needed. Strong organizational skills, empathy, and the ability to communicate effectively with diverse patient populations and interdisciplinary teams set top candidates apart. These capabilities are crucial for delivering high-quality, patient-centered care and ensuring compliance within Centene's managed care environment.
The most popular types of Centene Rn jobs in Staten Island, NY are:
The top searched job categories for Centene Rn jobs in Staten Island, NY are:
$30.58 - $55.09/hr
Other
Medical, Retirement, PTO
Posted 4 days ago
8.4
Based on 404 frontline employees who took The Breakroom Quiz
14th of 891 rated healthcare providers
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.
This position requires NY State Licensure as a RN, OT or PT
Position Purpose: Routinely reviews more challenging prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Assesses more complex authorization requests and provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
Collaborates with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care
Manages service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities
Provides feedback on opportunities to improve the authorization review process for members
Manages as appropriate with healthcare providers, utilization management team, and care management team to assess medical necessity of care
Partners with interdepartmental teams on projects within utilization management as part of the clinical review team
Manages and reviews all member’s clinical information in health management systems to ensure compliance with regulatory guidelines
Provides education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members
Develops in-depth knowledge of the prior authorization process and acts as a trainer to other team members
Performs other duties as assigned
Complies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 4 – 6 years of related experience.
Advanced clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
Strong knowledge of Medicare and Medicaid regulations preferred.
Strong knowledge of utilization management processes preferred.
License/Certification:
Pay Range: $30.58 - $55.09 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
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Health care and social assistance
10,000+ Employees
Saint Louis, MO, US
1984
