Clinical Review Clinician - Appeals (RN)
Centene•Nashville, TN
456d•$54,018 - $97,094
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About The Position
The Clinical Review Clinician - Appeals (RN) at Centene Corporation plays a crucial role in the Medical Management/Health Services team by performing clinical reviews to resolve and process appeals. This position involves reviewing medical records and clinical data to determine the medical necessity of services, ensuring compliance with policies, guidelines, and NCQA standards. The clinician will prepare case reviews, communicate with various stakeholders, and work collaboratively to enhance the appeals process.
