Remote Jobs at E Co

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. Candidates MUST reside in North Carolina. Position Purpose: Supervise nurses in a highly regulated department responsible for performing medical necessity case reviews for appropriateness of medical care and service. Supervise the day to day clinical operations and functions within the department, ensuring productivity and quality metrics are met. • Provide oversight and interpretation of state/federal regulations and NCQA standards impacting member appeals and grievances from a clinical perspective. Ensure that the clinical Appeals and Grievance department processes all cases in accordance with policies and procedures • Utilize clinical expertise to serve as a resource to the team regarding escalated or comp ...