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Home Based Centene Rn Jobs in Oregon (NOW HIRING)

Centene

Clinical Appeals Coordinator

OR · On-site +1

$33.71 - $60.67/hr

Centene is a diversified, national organization offering competitive benefits including a fresh ... License/Certification: LPN, LVN, or RN license. Specialty Therapy Requirement: Master's degree in ...

Centene

Clinical Data Audit Consultant

OR · On-site +1

$33.71 - $60.67/hr

Centene is a diversified, national organization offering competitive benefits including a fresh ... Registered Nurse - Must be Licensed in CA Pacific Time Zone Work Hours Position Purpose: The ...

TNAA TotalMed RN

Travel Home Health RN

Lake Oswego, OR · On-site

Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Home Health - Home Health RN - Travel Nurse ...

Centene

RN Readmission Manager, Payment Integrity

OR · On-site +1

Centene is transforming the health of our communities, one person at a time. As a diversified ... Actual pay will be adjusted based on an individual's skills, experience, education, and other job ...

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All JobsHome Based Centene Rn JobsHome Based Centene Rn Jobs in Oregon

Home Based Centene Rn information

What is the difference between Home Based Centene Rn vs Home Health Nurse?

AspectHome Based Centene RnHome Health Nurse
CertificationsRN license, possibly case management certificationRN license, often case management or hospice certification
Work EnvironmentPrimarily remote, working with insurance and case management teamsPrimarily in patients' homes, providing direct care
Employer & IndustryCentene Corporation, healthcare insurance industryHome health agencies, healthcare services industry

Both roles require an RN license and involve patient care, but the Home Based Centene Rn focuses on case management and insurance coordination remotely, while the Home Health Nurse provides direct patient care in home settings. The choice depends on whether you prefer remote administrative work or hands-on nursing in patients' homes.

What cities in Oregon are hiring for Home Based Centene Rn jobs?

Cities in Oregon with the most Home Based Centene Rn job openings:

Home Based Centene Rn jobs near you

Clinical Appeals Coordinator

Centene

OR • On-site, Remote

$33.71 - $60.67/hr

Full-time

Medical, Retirement, PTO

Posted 7 days ago

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.

RN, LVN/LPN - Licensed in Oregon

Pacific Time Work Hours

Position Purpose:
Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements.

  • Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested.
  • Prepare reviews for cases that did not meet criteria
  • Gather, analyze and report verbal and written information regarding member and provider clinical appeals, including information follow up
  • Prepare response letters for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards.
  • Maintain files and logs for all appeals
  • Coordinate with Medical Director(s) to clarify medical determinations or clinical rationale
  • Maintain current knowledge of NCQA and State regulations
  • Coordinate Fair Hearings with various internal departments and agencies
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience:
RN with 4+ years of clinical nursing and/or case management experience or LPN/LVN with 5+ years of clinical nursing or case management experience. Managed care or utilization review experience preferred.
License/Certification: LPN, LVN, or RN license.
Specialty Therapy Requirement: Master's degree in area of specialty therapy or equivalent experience. 3+ years of experience providing therapy services in healthcare or home health settings. Managed care or utilization review experience preferred.

Pay Range: $33.71 - $60.67 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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