centene

Candidates must reside in Mississippi. Standard schedule is Monday through Friday. Reviews inpatient admissions and elective procedures to determine medical necessity. Supports the Utilization Management team for Magnolia Health Plan. Position Purpose: Performs concurrent reviews, including determin

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: Conduct analysis, pricing, and risk assessment to estimate financial outcomes while supporting the Risk Adjustment team through data analytics, risk adjustment modeling, and complex data validation initiatives. Key Details: Candidates must have either 7+ years of actuarial experien

Position Purpose: The Senior Director, Healthcare Analytics leads analytic service delivery by aligning strategic objectives with the development of tools and capabilities and appropriate deployment of supporting analytic teams. The director serves in a leadership function spanning the needs of mult

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

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: 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

Position Purpose: Develop and maintain strategic partnerships between the health plan and contracted provider networks to advance value-based care initiatives, improve provider performance, and enhance member outcomes. Serve as a trusted advisor to providers and internal stakeholders by delivering d

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

Position Purpose:The Public Programs Coordinator is responsible for triaging and resolving member access to care issues and coordinating services with programs that are "carved out" of the health plan contract with the Department of Health Care Services, i.e. California Children's Services and Regio

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

Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Key Details: This remote position

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

Position Purpose: Apply all cash receipts into various systems and databases. Assist all major functions of the company including Accounts Payable and Billing. 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

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: Apply all cash receipts into various systems and databases. Assist all major functions of the company including Accounts Payable and Billing. 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

Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements. Review clinical information for all appeals utilizing nationa

Position Purpose: Design, implement and maintain training resources. Write, update, evaluate, and propose training programs supporting customer service, technical process documentation, operational systems, and e-learning development leveraging tools such as Articulate Storyline and Wellsaid Labs. P

Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Key Details: This remote position

Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Key Details: This is a remote, wor