centene

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. Key Details: A current California RN license is required for this RN Superviso

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 hybrid role

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: 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: 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: Manage the development (via consultation), delivery and continuous improvement of training related to the retention aspect of the Medicare line of business. Key details: The Learning Consultant role is fully remote. Candidates will be considered nationally. Responsibilities: Facili

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: Must possess an activ

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:Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Key Details: Must be a Board Certified Psychiatrist and licensed in California, Oregon, Washington or Nevada. Highly preferred th

Position Purpose:Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive

Position Purpose: Assist with the daily operations and support within the Quality Improvement department including data management, data reporting needs, and project management. Key Details: Remote position; candidates must reside in Nevada or Arizona. Preferred qualifications include experience wit

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 Hea

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 Hea

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 Hea

Provide national expertise to assist with the expansion of the business unit's position nationally, as a thought leader, regarding the foster care population, treatment, and service needs. Assist with the shaping of evidence based practices within the foster care provider network, stakeholder system

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: 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:Manage the workflow and all activities related to the investigation, review, resolution, recovery and settlement of complex claims issues along with Revenue Cycle Management. Key Details: Applicants for this job have the flexibility to work remote from home anywhere in the United St

Applicants for this job have the flexibility to work remote from home anywhere in the United States. 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, includin

Position Purpose: Role will lead strategy development and execution for the growing ICHRA product, including building provider networks with dedicated rates across current and future markets for both Centene employees and external members. Expand the provider network development and value based cont