centene

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: Manage annual development and creation of HEDIS Provider Toolkit and communications. Assist in the maintenance of an overarching communications practice in a managed care environment. Key Details: The Senior Communications Specialist is fully remote. Candidates will be considered n

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 Senior Quality Improvement Specialist is responsible for coordinating assigned regulatory, accreditation, clinical quality and/or service improvement programs. Functions as a leader for assigned health services initiatives handling multiple large-scale complex initiatives. Coll

Position Purpose: As part of Meridian Health Plan, this position supports Risk Adjustment programs and strategic initiatives by coordinating cross-functional efforts across clinical, operational, analytics, compliance, provider, and vendor teams. Responsibilities include supporting provider and memb

Position Purpose: Responsible for developing and conducting a variety of training programs and/or auditing tools for Centene's Pharmacy Services. The Trainer II is expected to be able to develop a full training program including content, agendas, activities, and assessments. Key Details: The Trainer

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: 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: With the Corporate Quality and Affordability Initiatives Finance team, you will analyze complex financial information and translate data into meaningful insights that support business decisions. Independently lead financial projects and initiatives, partnering with stakeholders to

Position Purpose:Work with the Pharmacists to accurately assist prescription orders in a timely manner Key Job Details: Pharmacy Technician II (Onsite Specialty Outreach - Customer Service - Phone Outreach with Data Entry). This Licensed Pharmacy Technician II role is located at 1311 W. Sam Houston

Position Purpose: Responsible for researching and analyzing Medicaid regulations and managing deliverables, as assigned. Serve as a liaison with the state Medicaid regulator. Perform trend analysis and assessment activities of high-level operational controls. Key Details: This fully remote role requ

Position Purpose: The Health Benefit Representative (HBR) is responsible for educating and assisting individuals with enrolling in affordable health insurance coverage through the NY State of Health Marketplace. This includes Medicaid (NYM), Child Health Plus (CHP), Essential Plan (EP), Qualified He

Position Purpose: The Health Benefit Representative (HBR) is responsible for educating and assisting individuals with enrolling in affordable health insurance coverage through the NY State of Health Marketplace. This includes Medicaid (NYM), Child Health Plus (CHP), Essential Plan (EP), Qualified He

Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. Monitors and tracks UM resources to ensure adherence to performance, complianc

Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Key Details: This fully remote role supports the Kentucky Market

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: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Per

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: Perform provider data management related activities based on plan and contract specifications and standard business rules – includes data analysis and entry, review of data via internet sites and other systems, and usage of multiple systems and applications to validate data is comp

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: Analyze