centene

Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and

Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education f

Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and

Position Purpose: The Case Auditor ensures accuracy, consistency, and compliance within care management operations by conducting comprehensive audits of case management activities, documentation, and processes. This role supports the organizations mission to deliver high-quality, member-centered car

This position is a field based role requiring the candidate to live in NJ. Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with

Position Purpose: Manages up-front third party evaluations and relationships with Delegation partners for performance management standards, financial responsibility and proactively implements appropriate business solutions as required. Acts as the critical link between our Delegation partners and in

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate

Position Purpose: This role serves as a trusted advisor to leaders and employees across the enterprise, providing guidance and support on a wide range of workplace matters while helping ensure fair, consistent, and compliant employment practices. The People Relations (PR) Partner manages employee re

Position Purpose: Support strategies to ensure successful maintenance and implementation of compliance programs that meet regulatory requirements for assigned products across the entire company. Key Details: Applicants for this job have the flexibility to work remote from home anywhere in the Contin

Position Purpose: Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/careg

Position Purpose: Develops and implements effective business solutions through research, audit, and analysis of data and/or business processes. Audits and validates routine pre and post payment claims to determine correct adjudication as well as compliance with corporate policies and procedures, and

Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote qu

Position Purpose: Responsible for clinical file assessments. Identifies monthly insights for improvement and participates in Interrater Reliability meetings. Aids in efforts to continuously develop review tools to ensure validity of criteria, and appropriately captures evidence of expected clinical

Position Purpose: Oversee operations, and business strategy utilizing cross-functional departments to meet strategic objectives. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not

Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education f

Position Purpose: Observe preceptors and participate in various projects to learn and develop skills related to the Managed Care industry. Develop clinical knowledge and skills by learning about various processes and functions within the Managed Care industry Observe processes and shadow preceptors

Centene's Sunshine State Health Plan is looking for a Florida licensed RN to support our Medicaid/Medicare MMA membership. Applicants must reside in the state of Florida, and be able to work a Monday - Friday 8am - 5pm schedule eastern time zone. Ideal applicants will have clinical experience workin

Position Purpose: Manage the business processes related to risk adjustment and quality improvement across Centene’s for assigned products and plans. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future

Position Purpose: Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. Learn various job functions within the Managed Care industry and explore various career opportunities Apply academic knowle

Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through hom