Centene Corporation

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...

Position Purpose: Serve as strategic, consultative partner to provide best-in-class employee relations expertise and services. Consult and provide advice, counsel and resolution to employees and managers on a broad range of employee relations matters, including policy interpretation and application, conflict resolution, performance management, progressive discipline and termination processes and practices Partner with HR Business Partners, HR Centers of Expertise (COEs), internal and external legal counsel, and other internal investigative bodies, as necessary to reach an effective resolution for employee matters Utilize case management system to track and manage employee matters to resolution Interpret and apply understanding of company policies and practices, employment laws and other regulations to provide advice, guidance or clarification for employee relations inquiries Education/Experience: Bachelor's degree in Business Administration, Human Resources, or related...

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. 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 Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes 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 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...

Position Purpose: Lead compliance audits of vendors. Identify audit scope and required audit tools. Ensure audit results are appropriated compiled and accounted for within designated audit tools Manage, audit, and monitor both internal and external vendors against CMS, contractual, Federal, State, and NCQA standards Review vendors documented processes against contractual, Federal, State, CMS, and NCQA standards Identify process gaps and deficiencies and communicate audit observations, recommendations, and process improvement opportunities Develop and implement quality improvement and corrective action plans based on risk analysis, audit findings, and vendor performance Develop audit tools based on contracted services with vendors and requirements defined by CMS, State, Federal, Medicaid and/or NCQA guidelines Maintain documentation on vendor performance and provide reports to subsidiaries as required for audits and risk assessments. Lead vendor performance oversight...

Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices. Serve as primary contact for providers serving as a liaison between the provider and the health plan Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on site and routing to the appropriate party for resolution Receive and respond to external provider related issues Initiate entry or change of provider related database information and oversee testing and completion of change request Investigate, resolve and communicate provider claim issues and changes Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem solving Perform provider...

Position Purpose: Serve as strategic, consultative partner to provide best-in-class employee relations expertise and services. Provide advice, counsel and resolution to employees and managers on complex and sensitive employee matters including policy interpretation and application, conflict resolution, performance management, progressive discipline and termination processes and practices Lead and conduct formal reviews regarding claims of harassment, discrimination, retaliation, workplace concerns and other issues to reach conclusion and present findings for further action and proposed remediation Act as escalation for highly complex matters to provide recommendations that mitigate risk. Partner and collaborate with HR Business Partners and business leaders to ensure optimal decisions and outcomes are made through influencing, coaching, and providing subject matter expertise that balance risk and business needs. Partner with HR Business Partners, HR Centers of Expertise...

Position Purpose: May include one or two areas of focus in support of disease management education and resource health information services to beneficiaries experiencing lifestyle changes, personal stress, anxiety and/or depression. This includes providing initial screening for appropriateness and type of information, whether local or national resources, while working on the telephone to empower the beneficiary to better self manage the disease and communication with their provider. Demonstrates regular, reliable and predictable attendance. Outbound Education: One-on-one and group based disease management education by telephone. Initial and post-intervention patient assessment. Program planning and update meetings. Inbound Resource Line Education: One-on-one and group heath resource information. Conducts brief needs assessment to assist the beneficiary and identify resources needed to assist with the appropriate condition presented by the beneficiary and/or group....

Position Purpose: Lead compliance audits of vendors. Identify audit scope and required audit tools. Ensure audit results are appropriated compiled and accounted for within designated audit tools Manage, audit, and monitor both internal and external vendors against CMS, contractual, Federal, State, and NCQA standards Review vendors documented processes against contractual, Federal, State, CMS, and NCQA standards Identify process gaps and deficiencies and communicate audit observations, recommendations, and process improvement opportunities Develop and implement quality improvement and corrective action plans based on risk analysis, audit findings, and vendor performance Develop audit tools based on contracted services with vendors and requirements defined by CMS, State, Federal, Medicaid and/or NCQA guidelines Maintain documentation on vendor performance and provide reports to subsidiaries as required for audits and risk assessments. Lead vendor performance oversight...

Position Purpose: Compile and analyze financial information for the company. 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 management. Perform financial forecasting and reconciliation of internal accounts. Run pre-established reports as well as development of new reports for internal stakeholders and regulatory agencies. Analyze metrics to evaluate financial impact of financial proposals. Valued Competencies: Technical Knowledge - Understands common accounting principles and financial schedules such as balance sheet or income statement reports Professional Knowledge - Ability to gain a working knowledge of functional areas and their expenses Takes Initiative - Anticipates requests for information Thinks critically -...

Position Purpose: Responsible for analytic data needs of the business unit. Manage multiple, variable tasks and data review processes, as well as mass data entry, maintenance, and update projects. Complete data audits and evaluations within core systems. Identify and resolve complex issues, including mass change updates, reconciliation projects, and the operationalization of data from various sources. Analyze and advise management of workflow issues and data integrity problems and offer recommendations on resolution. Develop and submit internal and external status reports. Create report and data reconciliation through Access, Excel, Business Objects and other reporting tools, to include provider data, claims data, membership data. Education/Experience: Bachelor's degree in related field or equivalent experience. 0-2 years of statistical analysis or data analysis experience. Advanced knowledge of Microsoft Applications, including Excel and Access. Experience with...

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 various systems Identify and analyze user requirements, procedures, and problems to improve existing processes Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations Identify ways to enhance performance management and operational reports related to new business implementation processes Coordinate with various business units and departments in the development and delivery of training programs Develop, share, and incorporate organizational best practices into business applications Diagnose problems and identify opportunities for process redesign and improvement Formulate and update departmental policies and procedures Serve as the subject matter expert on the...

Position Purpose: Assist in financial analysis, pricing and risk assessment to estimate outcomes. Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes Assist with developing probability tables based on analysis of statistical data and other pertinent information Analyze and evaluate changes in risk adjustment results Create and update routine reports Assist in evaluating the performance of new and existing corporate initiatives Participate in merger and acquisition analysis Education/Experience: Bachelor's degree in related field or equivalent experience. 2+ years of actuarial experience. License/Certification: Associate of the Society of Actuaries (ASA) (or equivalent international certification) 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...

Position Purpose: To maintain accurate financial records, prepare monthly financial statements and participate in special projects Prepare the monthly financial statement-reporting package Evaluate variances, account balances, etc. Account for cash through cash deposits, cash applications, collection and cash forecasting Analyzes financial information detailing assets, liabilities, and capital Prepares balance sheet, profit and loss statement, and other reports to summarize current and projected company financial position Education/Experience: Bachelor's degree in Accounting, Finance, related field or equivalent experience. 0-2 years experience in accounting, preferably in health care industry. 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,...

Position Purpose: The Business Analyst III will perform various analysis and interpretation to link business needs and objectives for assigned function. They will also analyze trends to recommend process and/or operational improvements to department Leaders via presentations and meetings. Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems Identify and analyze user requirements, procedures, and problems to improve existing processes Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations Identify ways to enhance performance management and operational reports related to new business implementation processes Coordinate with various business units and departments in the development and delivery of training programs Develop, share, and incorporate organizational best practices into business applications Diagnose...

Helping those who need it most is at the core of who we are at Centene Corporation. Make an impact as a part of our team in Charlotte, North Carolina! Do you have experience in any of the following fields; Customer Service, Administrative, Contracting, or Data Entry? If you are looking for a company that you can begin or grow your career with, we would like to speak to you! Review received contracts to ensure all paperwork needed is received, and filled out completely and accurately Manage inventory to ensure that new business contract deadlines are met. Interface and work with credentialing staff to ensure data and systems are in sync. Provide support to contract negotiators to ensure successful completion of contracting process. Identify gaps and risk in contracting process and coordinate with multiple departments to ensure contracting process is completed timely and accurately and within required established standards and guidelines. Maintain physical and...

Position Purpose: Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed. Verify eligibility and benefits Answer phone queues and process faxes within established standards Data enters authorizations into the system. Education/Experience: High school diploma or equivalent. 2+ years of customer service experience. Knowledge of medical terminology preferred. **Upon submission of application, you will receive an additional email from Centene with required assessment. Completion of the online assessment is Mandatory and they must be completed in order to progress to the next step in the hiring process** Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All...

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. 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 Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes 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 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...

Position Purpose: Provide initial and ongoing clinical assessment of treatment plans utilizing behavioral health expertise, industry standards, and policy requirements Evaluate providers' recommendations for patient services and objectives. Ensure alignment between patient diagnosis, program objectives, and services recommended Propose modifications to providers and discuss feedback on justifications for exceptions Evaluate patient progress over multiple years and guide board certified behavioral analysts in updating treatment plans and patient objectives Continuously research relevant publications for updates to scientific based guidelines Evaluate treatment plans, behavioral support plans and objectives for individuals with Autism Spectrum Disorder. Education/Experience: Master's degree in Applied Behavioral Analysis or related field. 5+ years of applied behavioral analysis experience. Extensive knowledge of applied behavior analysis within specific...

Position Purpose: Manage the compliance department functions, including but not limited to, periodic monitoring and auditing activities based on established compliance program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory, contractual and legal requirements. Manage approval and submission of timely and accurate contract and regulatory required report deliverables Oversee all contracts updates including creating new and updating existing contracts with Health Plans, States and consultants/vendors Conduct periodic assessments to ensure compliance against contract requirements Oversee creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with contract requirements or performance deficiencies Collaborate with Health Plans and States, where applicable, to maintain/improve customer satisfaction specific to delegated functions and compliance with contract...

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...