Top 7 centene prior auth nurse Jobs

DRG Reviewer
Centene —Missouri
- $70,100 - $126,200 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Clinical Review Nurse - Concurrent Review (RN)
Centene —California
- $27.02 - $48.55 an hour
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
2d
Substitute Health Aide, LPN/RN
Prior Lake-Savage Area Schools —Prior Lake, MN
- $27.06 - $31.12 an hour
- On call
- CPR Certification
- RN License
- BLS Certification
- Health insurance
- Flexible spending account
Utilization Review Clinician - ABA
Centene —Louisiana
- $27.02 - $48.55 an hour
- Full-time
- Remote
- LMFT
- Nursing
- RN License
- Paid holidays
- Health insurance
3d
Health Aide - Nurse LPN/RN
Prior Lake-Savage Area Schools —Prior Lake, MN
- $27.06 - $33.56 an hour
- 8 hour shift
- CPR Certification
- RN License
- First Aid Certification
- Health insurance
- Flexible spending account
Health Aide (RN or LPN Required) for Summer Programs
Prior Lake-Savage Area Schools —Prior Lake, MN
- $27.06 - $31.12 an hour
- Seasonal
- LPN
- Entry level
- Nursing
Special Needs Nurse for Summer Program (ESY)
Prior Lake-Savage Area Schools —Prior Lake, MN
- $38.32 - $40.46 an hour
- Seasonal
- Working with individuals with disabilities
- School
- Entry level

Related jobs to explore

Based on your search for centene prior auth nurse

Substitute Health Aide, LPN/RN
Prior Lake-Savage Area Schools —Prior Lake, MN
Typing, filing and answer phone calls and other related functions for maintenance of an. Current Red Cross First Aid and CPR certification.
$27.06 - $31.12 an hour
Health Aide - Nurse LPN/RN
Prior Lake-Savage Area Schools —Prior Lake, MN
H. Typing, filing and answer phone calls and other related functions for maintenance of an. Current Red Cross First Aid and CPR certification.
$27.06 - $33.56 an hour

I want to receive the latest job alert for centene prior auth nurse

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

centene prior auth nurse jobs near

Licensed Practical Nurse jobs in Prior Lake, MN

Utilization Review Nurse jobs in Louisiana

Clinical Nurse jobs in California

Nurse's Aide jobs in Prior Lake, MN

Licensed Practical Nurse jobs in Gainesboro, Tn

Licensed Practical Nurse jobs in Littleton, Nh

Licensed Practical Nurse Lpn jobs in Alabama

Licensed Practical Nurse jobs in Queen Creek, Az

Pediatric Nurse jobs in Charleston, Sc

Nurse Practitioner jobs in Omaha, Ne

Licensed Practical Nurse jobs in Ann Arbor, Mi

Licensed Massage Therapist jobs in Beaverton, Or

Utilization Management jobs in Maryland

Utilization Review Nurse jobs in Connecticut

Utilization Review Nurse jobs in San Leandro, Ca

Labor Delivery Nurse jobs in Harrisburg, Pa

Utilization Review Nurse jobs in New Orleans, La

Utilization Review Nurse jobs in Kyle, Tx

Utilization Review Nurse jobs in Las Vegas, Nv

Advocate Aurora Health Nurse Practitioner jobs in Milwaukee, Wi

DRG Reviewer

Centene -
Missouri

Apply Now

Job Details

Full-time
$70,100 - $126,200 a year

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Associate's degree
DRG

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:
Responsible for independently conducting comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure the accuracy of DRG assignment and reimbursement. Requires advanced expertise in ICD-10-CM/PCS coding and the ability to exercise discretion and professional judgment in assessing complex clinical information, validating diagnosis code assignments, and identifying discrepancies such as coding errors or upcoding. Operates with significant autonomy in supporting DRG validation reviews and appeals, interpreting regulatory requirements, and making authoritative decisions to ensure compliance with all applicable laws, payer contracts, and organizational policies.

Independently conducts comprehensive MS-DRG and APR-DRG coding and clinical validation reviews, exercising professional judgment to verify ICD-10-CM/PCS assignments, validate clinical diagnoses, identify discrepancies, and apply inpatient reimbursement rules without direct supervision.
Collaborates with the Medical Director on complex cases, providing expert recommendations and influencing review outcomes to ensure clinical accuracy and compliance.
Leads the evaluation of complex cases and proactively identifies opportunities to develop medical policy in the absence of established guidelines, demonstrating discretion and authority in decision-making.
Applies advanced knowledge of coding guidelines and clinical policies throughout the review process, making autonomous determinations regarding coding accuracy and regulatory compliance.
Prepares clear, concise, and well-supported audit findings, referencing authoritative sources such as AHA Coding Clinic and ICD-10 guidelines, approved Centene policies, and adopted clinical guidelines, ensuring recommendations reflect professional expertise.
Evaluates claims and medical records for compliance with state and federal regulations, payer contracts, and company policies, exercising independent judgment in interpreting requirements and resolving ambiguities.
Consistently meets or exceeds established quality and productivity standards while managing priorities and workflow autonomously.
Contributes to strategic initiatives by assisting in the development of audit concepts, identifying new audit opportunities, and selecting claims for review, demonstrating leadership in shaping audit methodologies.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience:

Associate's Degree in Health Information Management, Nursing, or related field required

4+ years experience of performing MS-DRG and APR-DRG coding required
2+ years experience of performing DRG reviews for a Payment Integrity vendor or Payer required
2+ years experience of using DRG encoder/grouper experience (TruCode/TruBridge, 3M, Optum Encoder, Webstrat, PSI, or similar) required
1+ years experience of inpatient hospital documentation improvement preferred

Licenses/Certifications:

RHIT - Registered Health Information Technician required or
RHIA - Registered Health Information Administrator required or:
CCS-Certified Coding Specialist required or:
Certified International Credit Professional (CICP) required or:
CCDS Certified Clinical Documentation Specialist required or: RN - Registered Nurse - State Licensure and/or Compact State Licensure Registered Nurse or Higher (in combination with a coding credential) preferred

Pay Range: $70,100.00 - $126,200.00 per year

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

Apply Now

Refine Your Search

centene prior auth nurse jobs

DRG Reviewer

Clinical Review Nurse - Concurrent Review (RN)

Substitute Health Aide, LPN/RN

Utilization Review Clinician - ABA

Health Aide - Nurse LPN/RN

Health Aide (RN or LPN Required) for Summer Programs

Special Needs Nurse for Summer Program (ESY)

Related jobs to explore

I want to receive the latest job alert for centene prior auth nurse

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected