Centene Corporation is seeking a fully remote Appeals Nurse Reviewer to conduct clinical reviews of medical records and data to determine medical necessity under NCQA standards.
The role supports NY-state regulatory considerations and operates Monday–Friday from a fully remote setting.
Requirements include an active NY RN license (BSN preferred), 2+ years in acute care or utilization management, and knowledge of NCQA and NY Medicaid/Medicare regulations. #J-18808-Ljbffr