Clinical Review Nurse – Prior Authorization, Hospice

Centene Corporation

. Analyze all prior authorization requests to determine medical necessity and appropriate level of care .

Posted 10/6/2026full-timeRemote • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in analyzing prior authorization requests and determining medical necessity in compliance with regulatory guidelines. Proficient in coordinating with healthcare providers and interdepartmental teams to enhance the authorization review process and ensure timely service delivery.

Highest-signal resume keywords

Medical Necessity AnalysisClinical ReviewUtilization ManagementLPN State LicensureRN Licensure

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Authorization Request AnalysisClinical DocumentationRegulatory ComplianceHealth Management SystemsService Authorization

Soft Skills

CollaborationCommunicationFeedback ProvisionEducation

Certifications & Qualifications

Licensed Practical Nurse (LPN)Registered Nurse (RN)

Industry Keywords

Medicare RegulationsMedicaid RegulationsUtilization ProcessesManaged CareHospice Care

About the role

Key responsibilities & impact

Analyze all prior authorization requests to determine medical necessity and appropriate level of care
Perform medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines and criteria
Work with healthcare providers and authorization teams to ensure timely review of services and requests
Coordinate with healthcare providers and interdepartmental teams to assess members’ medical necessity of care
Escalate prior authorization requests to Medical Directors when appropriate
Assist with service authorization requests for member transfer or discharge plans
Collect, document, and maintain members’ clinical information in health management systems
Educate providers and interdepartmental teams on utilization processes
Provide feedback on opportunities to improve the authorization review process
Comply with all policies and standards
Perform other duties as assigned

Requirements

What you’ll need

Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing
2–4 years of related experience
LPN (Licensed Practical Nurse) state licensure required
Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred
Knowledge of Medicare and Medicaid regulations preferred
Knowledge of utilization management processes preferred
Registered Nurse (RN) licensure with demonstrated experience in hospice and managed care environments preferred
Applicants must be able to work Monday through Friday, 8:00 a.m. to 5:00 p.m. in their local time zone
Weekend coverage required approximately once every six weeks, including Saturday and Sunday
Rotating holiday coverage required
Ability to work remotely from home anywhere within the United States

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation
Flexible scheduling during the week to accommodate weekend hours worked