Centene Corporation

* Applicants for this job can work remotely anywhere in the United States if they have a Kansas RN license or Compact license *   You could be the one who changes everything for our 26 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: Perform duties to conduct and manage the day to day operations of the utilization management function. Communicate with staff to facilitate daily department functions.   Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives. Promote compliance with federal and state regulations and contractual agreements. Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions. Develop, implement, and...

Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs Provide patient and provider education Facilitate member access to community based services Monitor referrals made to community based organizations, medical care and other services to support the...

You could be the one who changes everything for our 26 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.   About Us: We are revolutionizing the world of healthcare through digital transformation and building a world-class software engineering practice. Our high caliber team delivers leading edge technology and drives innovation to solve complex business challenges. Using collective innovation, we are turning visions into action and challenging what is possible to support the healthcare of 1 in 15 individuals.   About You: You are a highly collaborative, strategic risk-taker driven to make a difference and change the face of healthcare. You thrive in a supportive, result-oriented community and are committed to the relentless pursuit of continuous growth. You...

Position Purpose: Conduct screening and risk assessment interventions per program guidelines. Provide outreach and preventative care to members seeking services in the least restrictive environment. Identify special needs members through the completion of health screens and other resources. Educate providers, members and their families on behavioral health issues including symptoms, relapse prevention, stress reduction, lab work, and healthy lifestyle choices. Coordinate behavioral health treatment with PCP’s and behavioral health providers. Participate in the development and modification of care plans in conjunction with member, member’s family and managing physician to include, monitoring for treatment compliance and assisting with problem solving in breaking down barriers to treatment to include referrals to community resources. Coordinate urgent care evaluations when necessary. Assist members with locating providers and scheduling appointments as necessary. Assist...

You could be the one who changes everything for our 26 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: Support the development and maintenance of quality improvement related projects and reporting. Respond to quality improvement inquiries. Heavy chart monitoring and auditing of medical records Monitor the production of quality results reporting; analyze, track and trend the reporting results and report them to management Formulate and prepare ad-hoc and additional reporting requirements Recommend, develop, and implement quality improvement plans with management Train providers and staff in methodologies and tools of continuous quality improvement Prepare for and participate in meetings with State agencies, providers, and stakeholders Perform audits on to...

Position Purpose: 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. Research claims inquiry specific to the department and responsibility. 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. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs. Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the...

You could be the one who changes everything for our 26 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: Provide vision, strategy and operational leadership for the company’s health economics functions relating to business development, financial outcomes and contracting analysis. Oversee the provider capitation payment process, including accurate set-up of providers and rate cells. Serve as primary corporate analytical contacts for the company to support Centene’s and the Health Plans’ information needs to support strategic and operational goals and objectives.   Oversee Provider Capitation Process working with the Health Plan Contract Implementation Analyst teams to ensure accuracy of CAP requirements, managing communication between CIA and PDM teams to ensure consistent...

You could be the one who changes everything for our 26 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:  The Business Process Consultant leads large scale, cross-functional initiatives. Assists business case development for those proposed initiatives to which are assigned to ensure adequate assessment of opportunities, risks and return on investment. Facilitates the optimization of business unit performance by enhancing alignment of policy, process and technology and designing/implementing for future business needs as well. Leads large scale, cross-functional initiatives that are intended to drive performance improvement, financial gains, customer satisfaction and improved compliance. Provides policy guidance on assigned initiatives so that end-to-end processes...

**This position is primarily remote, some office attendance required (i.e. staff meetings) and field based that will require home visits once it is safe to do so therefore; candidates must be located in or near Joplin, MO." Offering $3,000 Sign On Bonus!   You could be the one who changes everything for our 26 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.   Our Comprehensive Benefits Package:   $3K Sign On Bonus Flexible work solutions including remote options, hybrid work schedules and dress flexibility Competitive pay Paid Time Off including paid holidays Health insurance coverage for you and dependents 401(k) and stock purchase plans Tuition reimbursement and best-in-class training and development   Position Purpose: Responsible for delivering of a...

**This position is primarily remote, some office attendance required (i.e. staff meetings) and field based that will require home visits once it is safe to do so therefore; candidates must be located in or near Cape Girardeau, MO." Offering $3,000 Sign On Bonus!   Position has remote availability. You could be the one who changes everything for our 26 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.   Our Comprehensive Benefits Package:   Flexible work solutions including remote options, hybrid work schedules and dress flexibility Competitive pay Paid Time Off including paid holidays Health insurance coverage for you and dependents 401(k) and stock purchase plans Tuition reimbursement and best-in-class training and development Position Purpose: Responsible for...

Candidates need to be located in Western Kansas Position Purpose: Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members’ current functional level and, in collaboration with the member, develop and monitor the Case Management Care Plan, monitor quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the Integrated Case Management functions. Collaborate with both medical and behavioral providers to ensure optimal care for members.   Work telephonically with patients identified as high risk, for both behavioral and physical health issues, and their providers to identify needs, set goals and implement...

Position Purpose: Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with discharge planning, arrange transportation; provide member assistance and participate in special utilization projects. Authorize, direct and monitor care for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care. Ensure compliance with all performance measures in regards to appeals, denials, higher level of care admission certification and concurrent review timeliness, Outpatient Treatment Report review timeliness, readmissions, and others as indicated. Interact with physicians and social workers for...

Position Purpose: Under direct supervision, the Operations Analyst II researches and analyzes enrollment data and/or business processes to develop and implement process improvements while acquiring a more advanced skill set for designing and implementing strategic solutions.   Gathers, evaluates, interprets, and analyzes data and business processes, or develops test scenarios to evaluate system defects. Presents information, recommendations and alternatives to facilitate management understanding of results and impact. Produces reports or file extracts for data analysis. Evaluates Enrollment department policies and procedures and recommends changes to improve the overall productivity and quality of department systems. Identifies opportunities to improve system processes and recommend changes to streamline operations and/or automate manual processes. At times, may assume responsibility for data integrity among various internal groups and/or between internal and external...

You could be the one who changes everything for our 26 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:   Compile and analyze financial information for the company. Lead various financial projects and assist in building a robust Estimate at complete process to monitor major contracts with ASC 606 in mind.  In this Finance Analyst III role, you will: Develop integrated revenue/expense analyses, projections, reports, and presentations Create and analyze monthly, quarterly, and annual reports and ensures financial information has been recorded accurately Identify trends and developments in competitive environments and presents findings to senior management Perform financial forecasting and reconciliation of internal accounts Handle complex and...

Position Purpose: Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care Conduct discharge planning Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems For New Hampshire and Massachusetts - home visits requiredPromote the quality and cost effectiveness of...

Position Purpose: Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner. Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources Provide assistance to members and/or providers regarding website registration and navigation Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application Process written customer correspondence and provide the appropriate level of timely follow up May coordinate member transportation and make referrals to other departments as appropriate Maintain performance and quality standards based on established call center metrics including turn-around times Foundation Care: Ensure pharmacy orders and invoices are distributed appropriately to patients and physicians; input patient information into Customer Relationship...

Position Purpose: Using multiple sources, this position researches Coordination of Benefits (COB) for potential dual coverage by other health insurance companies for all subscribers, spouses and affected dependants and determines which insurance is prime. COB research extends to all coverage offered by Health Net. Calls hospitals, insurance companies, medical groups and/or members requesting other insurance information as it pertains to dual coverage, eligibility and termination dates of coverage. Researches various COB information from lead sources including but not limited to Member Enrollment Forms, returned member request letters, prior claims, authorizations and Call Center Contacts. Makes COB determinations in accordance to COB guidelines (NAIC, CMS, DMHC, DOI or other resources). Updates the COB master file with other insurance information. Sends correspondence to members requesting COB information. Identifies need to re-adjudicate claims for members when Health...

*Applicants for this job have the flexibility to work remote.   You could be the one who changes everything for our 26 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.   About Us: We are revolutionizing the world of healthcare through digital transformation and building a world-class software engineering practice. Our high caliber team delivers leading edge technology and drives innovation to solve complex business challenges. Using collective innovation, we are turning visions into action and challenging what is possible to support the healthcare of 1 in 15 individuals.   About You: You are a highly collaborative, strategic risk-taker driven to make a difference and change the face of healthcare. You thrive in a supportive, result-oriented...

Position Purpose: Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner. Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources Provide assistance to members and/or providers regarding website registration and navigation Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application Process written customer correspondence and provide the appropriate level of timely follow up May coordinate member transportation and make referrals to other departments as appropriate Maintain performance and quality standards based on established call center metrics including turn-around times Foundation Care: Ensure pharmacy orders and invoices are distributed appropriately to patients and physicians; input patient information into Customer Relationship...

Position Purpose: Develop clinical knowledge and skills by learning about various processes and functions within the Managed Care industry Observe processes and shadow preceptors to gain hands on experience and become familiar with various clinical services Follow instructions and procedures provided by preceptor or manager in accordance with company guidelinesObserve preceptors and participate in various projects to learn and develop skills related to the Managed Care industry. Education/Experience: Current enrollment in an accredited clinical program. Candidates must be receiving course credit for participating in the Externship program. 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...