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Flexible Centene Rn Jobs in California (NOW HIRING)

Maxim Health Systems

RN - Flexible Home Health

Poway, CA · On-site

$38 - $42/hr

RN - Flexible Home Health Poway, California Hourly Pay: $38-$42 Maxim Healthcare is hiring for a Registered Nurse to work with Pediatric and/or Adult patients in their own homes. Experienced G-tube ...

Oakwood Healthcare

Registered Nurse RN

Irvine, CA · On-site

Competitive salary Flexible schedule Benefits/Perks Flexible Scheduling Competitive Compensation Careers Advancement Job Summary We are seeking a Registered Nurse to join our HOSPISE team. In this ...

RLNR Enterprises Inc.

Registered Nurse RN

Fremont, CA · On-site

... rate Flexible Scheduling Careers Advancement Job Summary We are seeking a compassionate and ... The RN will conduct insulin administration, perform skilled nursing assessments, and provide wound ...

Star Nursing

RN Registered Nurse

Anaheim, CA · On-site

$82/hr

Registered Nurse (RN) - Labor & Delivery (L&D) The Labor & Delivery RN provides specialized nursing ... Flexible scheduling to accommodate all preferences and lifestyles * Hotel Discounts * Referral ...

Star Nursing

RN Registered Nurse

Panorama City, CA · On-site

$82/hr

Registered Nurse (RN) - Labor & Delivery (L&D) The Labor & Delivery RN provides specialized nursing ... Flexible scheduling to accommodate all preferences and lifestyles * Hotel Discounts * Referral ...

Star Nursing

RN Registered Nurse

Harbor City, CA · On-site

$82/hr

Registered Nurse (RN) - Labor & Delivery (L&D) The Labor & Delivery RN provides specialized nursing ... Flexible scheduling to accommodate all preferences and lifestyles * Hotel Discounts * Referral ...

Star Nursing

RN Registered Nurse

Irvine, CA · On-site

$82/hr

Registered Nurse (RN) - Labor & Delivery (L&D) The Labor & Delivery RN provides specialized nursing ... Flexible scheduling to accommodate all preferences and lifestyles * Hotel Discounts * Referral ...

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Flexible Centene Rn information

What is the difference between Flexible Centene Rn vs Flexible Centene Lpn?

AspectFlexible Centene RnFlexible Centene Lpn
Required CredentialsRegistered Nurse (RN) licenseLicensed Practical Nurse (LPN) license
Work EnvironmentHospitals, clinics, home healthLong-term care, clinics, home health
Employer & Industry UsageHealthcare providers, insurance companiesLong-term care facilities, outpatient clinics
Common Search & ComparisonYesNo

The main difference between Flexible Centene Rn and Flexible Centene Lpn lies in their credentials and scope of practice. RNs hold a registered nurse license, allowing them to perform more complex medical tasks, while LPNs have a licensed practical nurse license with a more limited scope. Both roles work in healthcare settings, but RNs often handle more advanced patient care, making them suitable for different job requirements within Centene's healthcare services.

What cities in California are hiring for Flexible Centene Rn jobs?

Cities in California with the most Flexible Centene Rn job openings:

Flexible Centene Rn jobs near you

Grievance and Appeals Nurse

Centene Corporation

Sacramento, CA • On-site

$27.02 - $48.55/hr

Other

Medical, Retirement, PTO

Posted 2 days ago

New

Centene rating

8.4

Company rating: 8.4 out of 10

Based on 404 frontline employees who took The Breakroom Quiz

14th of 891 rated healthcare providers

Job 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.

Must be licensed in California. Will work on PST hours.

Position Purpose:

Facilitate medical necessity grievance, appeals and denials including disposition of denials notification letters, review of clinical information to determine if medical necessity criteria are met

  • Review clinical data to determine claim payment based on company policies and National Committee for Quality Assurance (NCQA) guidelines, including overturning denied claims, upholding the denials and submitting cases to the Medical Director for review

  • Recognize and identify potential quality care concerns by reviewing member grievances and potential quality issue cases.

  • Prepare case review for the Medical Director in cases where criteria are not met based on the additional clinical information received

  • Identify system improvements or individual care issues that result in failure to provide appropriate care to members or fail to meet service expectations

  • Provide input into corrective action plans for clinical and service events to improve decision-making or quality of care and services for internal and provider partner decisions

  • Generate appropriate appeal resolution communication to the member and provider in accordance with company policies and NCQA guidelines.

  • Create system authorization events for overturned denial decisions

  • Request additional information, as appropriate from provider(s) to facilitate timely appeals resolution

  • Gather and prepare case information for Administrative Law Hearings

  • Maintain appeals process within the prescribed NCQA timeframes and appeals turnaround database

  • Assist the Medical Director with revising, updating and/or creating new policies to satisfy NCQA and contractual requirements

  • May act as liaison between the provider and business to resolve issues

  • Performs other duties as assigned

  • Complies with all policies and standards

Education/Experience:

LPN or LVN with 3+ years of clinical nursing experience or RN with 2+ years of clinical nursing experience. Experience with utilization or appeals review preferred. Knowledge of InterQual criteria preferred.

License/Certification: Current state's RN, LPN, or LVN license.

Must be licensed in California.

Location: Position is remote. Will work PST hours.

Pay Range: $27.02 - $48.55 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

What Centene employees say

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Hours and flexibility

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