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Most recent job postings at centene
via Centene - Centene Corporation
posted_at: 3 days agoschedule_type: Full-time
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Provide support to medical, behavioral and social support staff to determine needs, eligibility and... services for members. Conduct screening and risk
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Provide support to medical, behavioral and social support staff to determine needs, eligibility and... services for members. Conduct screening and risk assessment interventions per program guidelines.
Identify special needs members through the completion of health screens and other resources.
Work with community outreach/member advocates to coordinate member care.
Educate providers and community resources on program components and available support services.
Educate members with special needs to foster compliance with program and positively impact outcomes.
Conduct site visits as appropriate for programs and provide support to other special programs.
Assist with modification and management of care plans under the direction of a Registered Nurse in conjunction with member, medical consenter or caregiver, Department of Family and Protective Services (DFPS) caseworker and family, if applicable, as well as the managing physician.
Education/Experience:
Bachelor’s degree in Social Work, Health Services, Behavioral Science, or related field, or equivalent experience. 2+ years of experience in a managed care environment or working with people who have disabilities and/or with vulnerable populations who have chronic or complex conditions. Other state specific requirements may apply.
Licenses/Certifications: LPN, LVN or LCSW preferred.
Pennsylvania requirements: Bachelor's degree or Registered Nurse License and 3+ years of experience in a social service or health care related setting, Licensed Practical Nurse and 5+ years of experience in a social service or health care related setting, or 7+ years of experience in a social service or health care related setting.
MHS Indiana plan only: Service coordinators must be registered nurses or licensed practical nurses, have at least one (1) year of experience serving the program population, have bachelor’s degrees, or associate's degrees with one (1) year of experience delivering healthcare/social services or case management, or at least two (2) or more years in care planning, care management, or delivering healthcare or social services. Services Coordinators are permitted to not have a degree if they have two or more years of care planning, care management, or delivering healthcare or social services. A portion of the Contractor’s Service Coordinators shall have experience in behavioral health so that they may appropriately assist members with behavioral health conditions.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
Position Purpose: Provide support to medical, behavioral and social support staff to determine needs, eligibility and... services for members. Conduct screening and risk assessment interventions per program guidelines.
Identify special needs members through the completion of health screens and other resources.
Work with community outreach/member advocates to coordinate member care.
Educate providers and community resources on program components and available support services.
Educate members with special needs to foster compliance with program and positively impact outcomes.
Conduct site visits as appropriate for programs and provide support to other special programs.
Assist with modification and management of care plans under the direction of a Registered Nurse in conjunction with member, medical consenter or caregiver, Department of Family and Protective Services (DFPS) caseworker and family, if applicable, as well as the managing physician.
Education/Experience:
Bachelor’s degree in Social Work, Health Services, Behavioral Science, or related field, or equivalent experience. 2+ years of experience in a managed care environment or working with people who have disabilities and/or with vulnerable populations who have chronic or complex conditions. Other state specific requirements may apply.
Licenses/Certifications: LPN, LVN or LCSW preferred.
Pennsylvania requirements: Bachelor's degree or Registered Nurse License and 3+ years of experience in a social service or health care related setting, Licensed Practical Nurse and 5+ years of experience in a social service or health care related setting, or 7+ years of experience in a social service or health care related setting.
MHS Indiana plan only: Service coordinators must be registered nurses or licensed practical nurses, have at least one (1) year of experience serving the program population, have bachelor’s degrees, or associate's degrees with one (1) year of experience delivering healthcare/social services or case management, or at least two (2) or more years in care planning, care management, or delivering healthcare or social services. Services Coordinators are permitted to not have a degree if they have two or more years of care planning, care management, or delivering healthcare or social services. A portion of the Contractor’s Service Coordinators shall have experience in behavioral health so that they may appropriately assist members with behavioral health conditions.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
via Centene - Centene Corporation
posted_at: 3 days agoschedule_type: Full-time
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Determine needs and eligibility of members for various services through field-based collaboration... with medical, behavioral, and social support staff.
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Determine needs and eligibility of members for various services through field-based collaboration... with medical, behavioral, and social support staff. Conduct screening and risk assessment interventions per program guidelines.
Conduct in-home face to face member assessments and telephonic outreach
Document assessments and contacts, develop and approve service plans, and ensure authorizations are completed
Conduct follow-up contacts or in-person visits to determine if services meet member’s needs
Assess member’s medical, safety and support service needs and coordinate the delivery of services
Provide education related to member’s health condition and care
Assist with modification and management of care plans under the direction of Registered Nurse in conjunction with member, medical consenter or caregiver, Department of Family and Protective Services caseworker and family, if applicable, as well as the managing physician
Maintain case record documents and enter information in an automated system, establishing a record for each member receiving services
Coordinate member care through collaboration with community outreach and member advocates, assigned service coordinators, and/or case managers
Educate providers and community resources on program components and available support services
Educate members to foster compliance with program and positively impact outcomes
75% travel required
Education/Experience: Bachelor’s degree in Social Work, Health Services, Behavioral Science or related field, or equivalent experience. 2+ years of experience in a managed care environment or working with people with disabilities and vulnerable populations who have chronic or complex conditions. Other state specific requirements may apply.
Licenses/Certifications: LPN, LVN, LCSW or RN preferred. Current state driver’s license.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
Position Purpose: Determine needs and eligibility of members for various services through field-based collaboration... with medical, behavioral, and social support staff. Conduct screening and risk assessment interventions per program guidelines.
Conduct in-home face to face member assessments and telephonic outreach
Document assessments and contacts, develop and approve service plans, and ensure authorizations are completed
Conduct follow-up contacts or in-person visits to determine if services meet member’s needs
Assess member’s medical, safety and support service needs and coordinate the delivery of services
Provide education related to member’s health condition and care
Assist with modification and management of care plans under the direction of Registered Nurse in conjunction with member, medical consenter or caregiver, Department of Family and Protective Services caseworker and family, if applicable, as well as the managing physician
Maintain case record documents and enter information in an automated system, establishing a record for each member receiving services
Coordinate member care through collaboration with community outreach and member advocates, assigned service coordinators, and/or case managers
Educate providers and community resources on program components and available support services
Educate members to foster compliance with program and positively impact outcomes
75% travel required
Education/Experience: Bachelor’s degree in Social Work, Health Services, Behavioral Science or related field, or equivalent experience. 2+ years of experience in a managed care environment or working with people with disabilities and vulnerable populations who have chronic or complex conditions. Other state specific requirements may apply.
Licenses/Certifications: LPN, LVN, LCSW or RN preferred. Current state driver’s license.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
via Centene - Centene Corporation
posted_at: 3 days agoschedule_type: Full-time
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Oversee the regional staff to ensure health plan programs are designed, implemented, and operated... within defined parameters.
Ensure Corporate’s strategic
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Oversee the regional staff to ensure health plan programs are designed, implemented, and operated... within defined parameters.
Ensure Corporate’s strategic objectives are maintained at the regional health plan facilities.
Assist in the development and implementation of work processes and operational systems.
Research changes and updates to government regulations or health plan guidelines.
Provide on-call duties as assigned for potential interventions and follow up on urgent call issues.
Identify trends and root causes of problems; provide recommendations for improvements, documentation, and training.
Participate in the integration of specialty products in health plan operations.
Education/Experience: Bachelor’s degree in Nursing, Social Work, Health Care Administration, related field or equivalent experience. 7+ years of nursing, social work, healthcare administration, or patient/community advocacy experience. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
License/Certification: Current state’s nursing license or Licensed Clinical Social Worker (LCSW) preferred.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
Position Purpose: Oversee the regional staff to ensure health plan programs are designed, implemented, and operated... within defined parameters.
Ensure Corporate’s strategic objectives are maintained at the regional health plan facilities.
Assist in the development and implementation of work processes and operational systems.
Research changes and updates to government regulations or health plan guidelines.
Provide on-call duties as assigned for potential interventions and follow up on urgent call issues.
Identify trends and root causes of problems; provide recommendations for improvements, documentation, and training.
Participate in the integration of specialty products in health plan operations.
Education/Experience: Bachelor’s degree in Nursing, Social Work, Health Care Administration, related field or equivalent experience. 7+ years of nursing, social work, healthcare administration, or patient/community advocacy experience. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
License/Certification: Current state’s nursing license or Licensed Clinical Social Worker (LCSW) preferred.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
via Centene - Centene Corporation
posted_at: 6 days agoschedule_type: Full-time
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
• * The preferred location for this position is Sioux City as the role requires approximately 50% local travel in... Woodbury and Monona county. Applicants have the flexibility
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
• * The preferred location for this position is Sioux City as the role requires approximately 50% local travel in... Woodbury and Monona county. Applicants have the flexibility to work remotely from their home the remaining time **
Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination.
Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development
Monitor delivery of services and follow-up with members, caregivers, or provider s through in person visits and telephonic contact
Authorize and coordinate referral for services
Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care
Assist in coordinating the development of informal or voluntary services to integrate into the member care plan
Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services
Assist member with filing and resolving complaints and appeals
Education/Experience: Bachelor's degree and 2+years of experience in a social service or health care related setting or Registered Nurse License and 2+ years of experience in a social service or health care related setting.
Licenses/Certifications: Valid driver's license
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
• * The preferred location for this position is Sioux City as the role requires approximately 50% local travel in... Woodbury and Monona county. Applicants have the flexibility to work remotely from their home the remaining time **
Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination.
Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development
Monitor delivery of services and follow-up with members, caregivers, or provider s through in person visits and telephonic contact
Authorize and coordinate referral for services
Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care
Assist in coordinating the development of informal or voluntary services to integrate into the member care plan
Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services
Assist member with filing and resolving complaints and appeals
Education/Experience: Bachelor's degree and 2+years of experience in a social service or health care related setting or Registered Nurse License and 2+ years of experience in a social service or health care related setting.
Licenses/Certifications: Valid driver's license
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
via Centene - Centene Corporation
posted_at: 7 days agoschedule_type: Full-time
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
• **NOTE: This is a hybrid-remote role with 50% travel. Applicants must have a bachelor’s degree as well as care... management experience with the following populations:
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
• **NOTE: This is a hybrid-remote role with 50% travel. Applicants must have a bachelor’s degree as well as care... management experience with the following populations: elderly, persons with disabilities, persons with developmental disabilities. Applicants must reside in DuPage and Kane County, Illinois within the following territory: Carol Stream, Bartlett, Bloomingdale, Glendale Heights. ***
Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination.
• Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development
• Monitor delivery of services and follow-up with members, caregivers, or provider s through in person visits and telephonic contact
• Authorize and coordinate referral for services
• Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care
• Assist in coordinating the development of informal or voluntary services to integrate into the member care plan
• Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services
• Assist member with filing and resolving complaints and appeals
• Applicants must reside in DuPage and Kane County, Illinois within the following territory: Carol Stream, Bartlett, Bloomingdale, Glendale Heights.
Education/Experience: Bachelor’s degree or Registered Nurse License and 2+ years of care management experience, Licensed Practical Nurse and 4+ years of care management experience, or 6+ years of care management experience. Home health, discharge planning, or long term care experience preferred.
Licenses/Certifications: Valid driver's license. LPN or RN preferred.
• ** Additional Details:
• Line of Business: Illinois Health Plan
• Department: MED-Case Management / Long Term Care Coordination
• Caseload: Aging and Physical Disability waiver members
• Territory: DuPage and Kane County Illinois (Cities: Carol Stream, Bartlett, Bloomingdale, Glendale heights area). Work-from-home case management role with local in-home visits (up to 50% travel) ***
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
• **NOTE: This is a hybrid-remote role with 50% travel. Applicants must have a bachelor’s degree as well as care... management experience with the following populations: elderly, persons with disabilities, persons with developmental disabilities. Applicants must reside in DuPage and Kane County, Illinois within the following territory: Carol Stream, Bartlett, Bloomingdale, Glendale Heights. ***
Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination.
• Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development
• Monitor delivery of services and follow-up with members, caregivers, or provider s through in person visits and telephonic contact
• Authorize and coordinate referral for services
• Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care
• Assist in coordinating the development of informal or voluntary services to integrate into the member care plan
• Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services
• Assist member with filing and resolving complaints and appeals
• Applicants must reside in DuPage and Kane County, Illinois within the following territory: Carol Stream, Bartlett, Bloomingdale, Glendale Heights.
Education/Experience: Bachelor’s degree or Registered Nurse License and 2+ years of care management experience, Licensed Practical Nurse and 4+ years of care management experience, or 6+ years of care management experience. Home health, discharge planning, or long term care experience preferred.
Licenses/Certifications: Valid driver's license. LPN or RN preferred.
• ** Additional Details:
• Line of Business: Illinois Health Plan
• Department: MED-Case Management / Long Term Care Coordination
• Caseload: Aging and Physical Disability waiver members
• Territory: DuPage and Kane County Illinois (Cities: Carol Stream, Bartlett, Bloomingdale, Glendale heights area). Work-from-home case management role with local in-home visits (up to 50% travel) ***
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
via Centene - Centene Corporation
posted_at: 16 days agoschedule_type: Full-time
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State... Fair Hearing. Perform duties as the point of contact
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State... Fair Hearing. Perform duties as the point of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators.
Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ plus years of experience in healthcare/law, grievances and appeals. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
Position Purpose: Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State... Fair Hearing. Perform duties as the point of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators.
Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ plus years of experience in healthcare/law, grievances and appeals. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
via Centene - Centene Corporation
posted_at: 7 days agoschedule_type: Full-time
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
• Applicants for this job have the flexibility to work remote from home anywhere in the United... States
Position Purpose: Perform various analysis and interpretation
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
• Applicants for this job have the flexibility to work remote from home anywhere in the United... States
Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function.
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation
• Identify ways to enhance performance management and operational reports related to new business implementation processes
• Develop and incorporate organizational best practices into business applications
• Lead problem solving and coordination efforts between various business units
• Assist with formulating and updating departmental policies and procedures
Education/Experience:
Bachelor’s degree in related field or equivalent experience. 2-4 years of business process or data analysis experience, preferably in healthcare. Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Project management experience preferred.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
• Applicants for this job have the flexibility to work remote from home anywhere in the United... States
Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function.
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation
• Identify ways to enhance performance management and operational reports related to new business implementation processes
• Develop and incorporate organizational best practices into business applications
• Lead problem solving and coordination efforts between various business units
• Assist with formulating and updating departmental policies and procedures
Education/Experience:
Bachelor’s degree in related field or equivalent experience. 2-4 years of business process or data analysis experience, preferably in healthcare. Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Project management experience preferred.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
via Centene - Centene Corporation
posted_at: 7 days agoschedule_type: Full-time
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Design and implement programs, policies, and practices to ensure State and Federal program... contract compliance, as well as compliance with
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Design and implement programs, policies, and practices to ensure State and Federal program... contract compliance, as well as compliance with federal and state legal and regulatory requirements.
• Manage the compliance/reporting staff.
• Oversee the day-to-day health plan policies and procedures to ensure federal and state regulatory compliance.
• Validate state and federal deliverable reports for accuracy and ensure timeliness of submission.
• Review and analysis of health plan deliverables and data to identify trends in performance and opportunities for improvement.
• Ensure timely, accurate and appropriate submission of all State filings related to health plan licensure.
• Act as a resource to staff in all health plan departments related to contract and reporting requirements and regulatory compliance.
• Act as a liaison with State and/or federal agency staff in response to inquiries and requests for information. Interact with Corporate compliance staff, and serve as primary health plan liaison with the Corporate Special Investigations Unit related to fraud and abuse.
• Conduct oversight audits of health plan procedures and processes to ensure compliance with contractual and regulatory requirements.
• Coordinate with Marketing Manager and Delegation Oversight Manager for applicable activities and initiatives.
• Conduct/manage training programs for all health plan staff as required by contract and applicable regulatory requirements.
Education/Experience: Bachelor's’ degree in related field. 4+ years of compliance/regulatory experience in a health care and/or managed care setting/organization. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
Position Purpose: Design and implement programs, policies, and practices to ensure State and Federal program... contract compliance, as well as compliance with federal and state legal and regulatory requirements.
• Manage the compliance/reporting staff.
• Oversee the day-to-day health plan policies and procedures to ensure federal and state regulatory compliance.
• Validate state and federal deliverable reports for accuracy and ensure timeliness of submission.
• Review and analysis of health plan deliverables and data to identify trends in performance and opportunities for improvement.
• Ensure timely, accurate and appropriate submission of all State filings related to health plan licensure.
• Act as a resource to staff in all health plan departments related to contract and reporting requirements and regulatory compliance.
• Act as a liaison with State and/or federal agency staff in response to inquiries and requests for information. Interact with Corporate compliance staff, and serve as primary health plan liaison with the Corporate Special Investigations Unit related to fraud and abuse.
• Conduct oversight audits of health plan procedures and processes to ensure compliance with contractual and regulatory requirements.
• Coordinate with Marketing Manager and Delegation Oversight Manager for applicable activities and initiatives.
• Conduct/manage training programs for all health plan staff as required by contract and applicable regulatory requirements.
Education/Experience: Bachelor's’ degree in related field. 4+ years of compliance/regulatory experience in a health care and/or managed care setting/organization. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
via Centene - Centene Corporation
posted_at: 9 days agoschedule_type: Full-time
You could be the one who changes everything for our 28 million members as a Customer Care professional at Centene. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner...
• Gather and verify demographic information
• Document calls, ensure
You could be the one who changes everything for our 28 million members as a Customer Care professional at Centene. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner...
• Gather and verify demographic information
• Document calls, ensure completion and accuracy and submit reporting to management
• Gather information and encourage callers to perform a specific action based on the needs of the call campaign
• Identify barriers being experienced by callers and solve any issue that may arise during a call campaign, including escalating potential crisis calls
• Maintain performance and quality standards based on established call experience guidelines
• Identify any trends related to outbound calls that may provide policy or procedure improvements or may affect the efficiency and success of the call campaign
Education/Experience: High school diploma or equivalent. Six months experience as a Customer Service Representative or previous Call Center, Healthcare or insurance experience. Should be proficient in understanding the working of a call center environment. Skilled in customer service, verbal communication over the phone. Claims processing, billing and/or coding experience preferred.
For Foundation Care Only: Ability to complete Missouri Registered Pharmacy Tech application on 1st day of hire to obtain non-restricted Missouri Registered Pharmacy Tech within 30 days of hire OR Active Missouri Registered Pharmacy Tech license.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner...
• Gather and verify demographic information
• Document calls, ensure completion and accuracy and submit reporting to management
• Gather information and encourage callers to perform a specific action based on the needs of the call campaign
• Identify barriers being experienced by callers and solve any issue that may arise during a call campaign, including escalating potential crisis calls
• Maintain performance and quality standards based on established call experience guidelines
• Identify any trends related to outbound calls that may provide policy or procedure improvements or may affect the efficiency and success of the call campaign
Education/Experience: High school diploma or equivalent. Six months experience as a Customer Service Representative or previous Call Center, Healthcare or insurance experience. Should be proficient in understanding the working of a call center environment. Skilled in customer service, verbal communication over the phone. Claims processing, billing and/or coding experience preferred.
For Foundation Care Only: Ability to complete Missouri Registered Pharmacy Tech application on 1st day of hire to obtain non-restricted Missouri Registered Pharmacy Tech within 30 days of hire OR Active Missouri Registered Pharmacy Tech license.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law Show more details...
via Workday
posted_at: 22 hours agoschedule_type: Full-timework_from_home: 1
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform duties to assist in activities related to the medical and psychosocial aspects of utilization... and coordinated care. Initiate authorization requests
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform duties to assist in activities related to the medical and psychosocial aspects of utilization... and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Maintain integrity of PHI. Maintain working relationships with other departments. Research claims inquiry specific to the department and responsibility. Attend ongoing training and inservices as directed. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census. Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Answers phone queues and faxes within established standards. Screen members by priority for CM assessment. Coordinates services with community based organizations. Attends marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material. Helps develop marketing and outreach meetings as directed to represent the health plan. Train new Program Coordinators on system and usage. Guide staff regarding benefits, authorization requirements and policy and procedure. Data enters assessments and authorizations into the system. Maintains database as directed. Education/Experience: High school diploma or equivalent; 3-5 years managed care setting, medical office or facility setting with demonstration of medical administration duties. Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology. Licenses/Certifications: LPN license highly preferred. Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email recruiting@centene.com. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well
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