🚨 Centene is Hiring: Manager, Clinical Review
Remote Clinical Leadership Opportunity | Healthcare Integrity | Fraud, Waste & Abuse
Are you a nurse leader with experience in Clinical Review, SIU, Fraud, Waste, Abuse &, Coding ? This could be your next leadership opportunity.
Join Centene in a remote clinical leadership role where you’ll lead a team of clinical investigators, oversee complex FWA cases, apply your clinical expertise to identify potential healthcare fraud and abuse, and collaborate with providers and key stakeholders across multiple markets.
🔎 What makes this opportunity stand out?
Lead and develop a team of clinical investigators
Review and evaluate complex Fraud, Waste & Abuse cases
Apply clinical expertise to identify trends, risks, and potential concerns
Partner with providers and internal stakeholders on complex cases
Support healthcare integrity and appropriate utilization of services
Make an impact across multiple markets while working 100% remotely
If you have a strong clinical background and are ready to take your expertise into healthcare investigations and clinical leadership, this is an opportunity worth exploring.
👉 Interested or know someone who would be a great fit? Apply today!
Position Purpose: Manage the resources and results of the clinical reviews that are conducted as a result of providers/claims identified for potential fraud, waste and/or abuse.
Education/Experience:
Bachelor's Degree For Physical Health: Nursing, related field or equivalent experience required
5+ years For Physical Health: Medical coding and/or nursing experience required
For Physical Health: Strong medical terminology and research techniques required
Knowledge of CPT code billing required
Previous experience managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff required
For Physical Health: Clinical experience including hospital or clinic setting, emergency room and/or physician office preferred
For Physical Health: Certified Professional Coder. RN or LPN a plus preferred
Pay Range: $87,700.00 - $157,800.00 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.