Medical Review Specialist III
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Texas • United States
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Salary
💰 $23 - $39 per hour
About the role
- Supports peer-to-peer (P2P) processes, including scheduling P2P between Medical Directors and providers according to internal policies and requirements.
- Manages and reviews Medical Director’s workflow queue in the medical management system and adjusts workflows as needed based on escalations and scheduling.
- Schedules peer-to-peer (P2P) between Medical Directors and providers to discuss clinical services including the approval of a prior authorization.
- Manages turn-around times for P2P authorizations to ensure P2P are conducted within a timely manner in accordance with regulations and policies.
- Develops in-depth knowledge of P2P process, best practices, and internal policies and requirements.
- Serves as front-line support in communicating with providers and/or vendors.
- Provides support with all communications between clinical staff, providers, and Medical Directors.
- Works with different teams to identify process improvements and efficiencies within the P2P process.
- Performs other duties as assigned.
- Complies with all policies and standards.
Requirements
- Requires a High School diploma or GED
- Requires 2 - 4 years of related experience.
- Strong knowledge of medical terminology and practices preferred.
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical management systempeer-to-peer (P2P) processesprior authorization
Soft Skills
communicationworkflow managementprocess improvementteam collaboration
Certifications
High School diplomaGED