You could be the one who changes everything for our 26 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.
Position Purpose: The Utilization Review (UM) Clinician (LPN) performs clinical reviews to assess medical necessity of a broad range of outpatient and inpatient services, while maintaining compliance with all regulatory requirements.
Interfaces with medical directors, and both internal and external stakeholders, with regard to coverage for services, contract benefits and alternate resources available.
This position interfaces frequently with treating providers in the gathering of clinical information and may also provide education on the medical review process.
The Utilization Management clinician (LPN) makes coverage decisions based on specific criteria including Milliman.
Frequently collaborates with Fidelis medical directors in determining coverage of requested services.
Interacts with members to assist with accessing appropriate resources for requested services.
Education/Experience: Associate’s degree preferred; Bachelors Degree preferred. 1-3 years Utilization Review experience preferred. Managed care experience preferred
License/Certification: NYS LPN License Required
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
TITLE: Utilization Management Clinician LPN
LOCATION: Latham, New York
Company - Public
Latham, NY, 12110and others
Finance & Insurance Companies, Insurance Agency & Brokerage Firms
|Job category||Distribution||6 months||1 year|
|Consulting & Upper Management||7.8%||43%||2,201%|
|Marketing & PR||7.2%||52%||2,185%|
|Non-Profit & Volunteering||6.7%||42%||3,317%|
|Government & Military||1.7%||4%||2,397%|
|Arts & Entertainment||0.4%||21%||1,858%|
|Transportation & Logistics||<0.1%||75%||760%|
|Hospitality & Travel||<0.1%||40%||700%|