centene

Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to ment

Position Purpose: Assist the Chief Medical Officer to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Key Details: This role requires a Board Certified Physician that is licensed in the state of Georgia. Provides medical leadership

Position Purpose: Oversee and direct all clinical operations, including care management and coordination, and utilization management Establish the business unit’s clinical strategic vision, objectives, policies and procedures to ensure delivery of cost effective, clinically appropriate services in a

Position Purpose: Lead a team of professionals responsible for the strategic and operational execution of the strategic plan, typically including individual state initiatives as well as broad, national strategic efforts. Responsible for a large budget that is very complex in nature, in support of th

Position Purpose: Job Description: The Project Management Undergraduate Intern will support the Business Implementation & Strategic Initiatives team in planning and executing key projects. This fully remote position may be performed from any of the 50 U.S. states and provides hands-on experience wit

Position Purpose: Lead clinical coding compliance nurses and non-clinical team members through the code editing adjudication process that includes prepay compliance, adjustments, and appeals for multiple code editing software systems. Ensure Coding Analytics team consistently meets production standa

Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care

Position Purpose: Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. Key details: Centene is hiring a remote Supervisor, Behavioral Health Utilization Management, to suppor

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 available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Position Purpose:Responsi

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: Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. We're seeking detail-oriented and strong communicators who are passionate about pharmacy and improving the health of the co

Position Purpose: Plans, organizes, monitors, and oversees projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives. Key Details: Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Su

Position Purpose:Works with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction with members and providers at large IPA and/or group practices. Serves to collaborate with p

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:Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care p

Position Purpose: Analyze integrated and extensive datasets to extract value, which directly impacts and influences business decisions. Work collaboratively with key business stakeholders to identify areas of value, develop solutions, and deliver insights to reduce overall cost of care for members a

Position Purpose: Responsible for guiding the strategic product direction for department. Responsible for the product road map, development and implementation, opportunity identification, business case development, industry research, and new product introduction across the product set. Responsible f

Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and thei

Position Purpose:Oversee and monitor the performance of both internal and external cost recovery and cost containment initiatives according to targeted project metrics and forecasted recovery and cost avoidance goals for each Health Plan. Manage internal and external vendors cost avoidance and cost

Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to ment