Centene Corporation

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Analysis of MRA data to identify patterns and development of interventions at the provider and market level. Candidate Education: Required A High School or GED Essential Functions: * Subject matter experts for proper risk adjustment coding and CMS data validation Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of CMS risk adjustments guidelines are met. Analyze MRA data to...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Provide health education and coaching to members tailored to issues identified within treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services Assist members with social determinants of health including access to exercise and healthy food Promote activities focused on the health of a patient and their community, including without limitation outreach, quality improvement, and patient panel management Coordinate community-based management of medication therapy Qualifications Provide specialty service care coordination to beneficiaries. Ensure appropriate services are delivered by specialty...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. 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...

Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus. You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Work with the Pharmacists to accurately prepare prescription orders in a timely manner Prepare, count, label, and package pharmaceuticals for Pharmacist approval Interact with various departments to provide accurately dispensed prescriptions on a timely basis Accurately calibrate equipment and document calibration according to policy Assist with the maintenance of pharmacy temperature and cleaning logs and documents maintenance Complete compounding records and other pharmacy records as indicated Verify completed compounding...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Manage compliance department functions and vendor activities as follows: Analyze, interpret, and respond to questions pertaining to contracts, RFPs, and amendments pertaining to relationships with regulators and vendors. Coordinate the development of timely responses to regulatory complaints, issues, and information requests. Assist in the coordination of regulatory or corporate audits and assessments. Coordinate with Corporate Vendor Management team regarding vendor expectations, performance, and procedures. Research and resolve claim disputes with vendor, member or provider issues and route to appropriate person(s) for resolution. Conduct regular vendor...

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail Education/Experience: High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills. Centene is an...

You could be the one who changes everything for our 24 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national Fortune 50 and rapidly growing organization, our mission is fueled by exceptional talent. To support our rapid growth, we are building our East Coast headquarters and innovation hub here in Charlotte. 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...

You could be the one who changes everything for our 25 million members as a Behavioral Health Clinical Care Manager on the Clinical team. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national Fortune 24 and rapidly growing organization, exceptional talent fuels our mission. Do you thrive in a supportive, result-oriented community and are committed to the relentless pursuit of continuous growth? As part of our clinical group, the member-focused care you deliver will make a difference and change the face of healthcare for Texas. Are you ready to make an impact? As a Behavioral Health Clinical Care Manager, you will: Handle inbound and outbound member and provider calls on a clinical phone queue. Ensure members receive behavioral health services appropriate to clinical need. Triage crisis calls to assist with stabilization and access to emergency evaluation. Coordinate services with other departments, such as medical...

Position Purpose: The HARP Service Coordinator provides administrative and non-clinical member service support for members of the HealthierLife plan. The HARP Service Coordinator provides front-line response to members and providers requesting information on or access to Behavioral Health services. The position facilitates access, for clinical case management staff, to non-emergency care and triage requests as well as urgent and emergency care requests. Coordination and Documentation: Coordinates services and care related to HARP members, including scheduling appointments for Members, arranging transportation to appointments when necessary, obtaining health records from providers, identifying and securing providers for the Members, obtaining and documenting authorization information, placing appointment reminder and follow-up calls, Complete all required and related paperwork and documentation in information systems/ electronic record (i.e. authorizations, securing provider...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Provide health education and coaching to members tailored to issues identified within treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services Assist members with social determinants of health including access to exercise and healthy food Promote activities focused on the health of a patient and their community, including without limitation outreach, quality improvement, and patient panel management Coordinate community-based management of medication therapy Qualifications Provide specialty service care coordination to beneficiaries. Ensure appropriate services are delivered by specialty...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Help Agile adoption with team by promoting Agile culture and mindset through one on one mentoring, training and workshops with team from business and IT. Support scrum team in delivery of sprint goals and iterative delivery of software solutions that deliver business value. Partner with the product owner to support product backlog definition / refinement / prioritization to feed sprints. Proactively eliminate barriers, coach team members on best practices and run scrum ceremonies. Guide the team on how to leverage Agile/Scrum practices and values to maximize the delivery of business value. Support and educate the Product Owner in applying the scrum framework and agile...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Health Benefit Representative (HBR) sells Fidelis Care products and services by first identifying membership growth opportunities in an assigned territory and then meeting or exceeding production goals by enrolling individuals in the appropriate Fidelis Care product. The HBR fully and thoroughly understands and is able to effectively explain, communicate, recommend and enroll individuals into the best product for their unique needs. In-depth knowledge of all Fidelis Care products, including "metal" products offered through the New York State of Health (NYSOH), Medicaid Managed Care, Child Health Plus, Medicare, MLTC, FIDA and HARP. Ability to answer product feature and...

Position Purpose: You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Support and facilitate 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 Coordinate with various business units and departments for problem solving, process improvement, and other business initiatives Identify risks and concerns within projects and business initiatives Develop, share, and...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Responsible for retaining current membership by assisting members with the completion and processing of Government health program applications; responds to all inquiries regarding the application process from both new and existing members and strives to meet daily production metrics designed to achieve higher membership retention. Provide member resolution by researching, analyzing, and documenting inquiries regarding program eligibility; answer application and service questions regarding the programs and services to maintain and attract membership; conduct follow-up calls reminding members to return recertification applications, and request missing documentation if...

Position Purpose: Learn various job functions within the Managed Care industry and explore various career opportunities Apply academic knowledge and learn new skills by contributing to various projects Communicate project status and results to staff mentors and management Research various legal, regulatory, and other topics within functional area and industry Attend training and development presentations to enhance professional competencies Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. Experience/Experience: Bachelor's degree. Must be enrolled in a graduate program at an accredited university or college in a field related to the hiring department through the internship period. Preferred Qualifications: -Current enrollment in juris doctorate (J.D.) graduate program Centene is an equal opportunity employer that is committed to diversity, and values the ways in...

You could be the one who changes everything for our 25 million members as a Software Developer Intern. This position is on the Modular Core team in our Health Plan Systems Department of Centene Technologies. Design, build, test and maintain scalable and stable off the shelf application or custom built technology solutions to meet business needs. Position Purpose: Learn various job functions within the Managed Care industry and explore various career opportunities Apply academic knowledge and learn new skills by contributing to various projects Research various legal, regulatory, and other topics within functional area and industry Attend training and development presentations to enhance professional competencies Understanding of and some proficiency with Angular, NodeJS, HCD and Cloud. Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. Experience/Experience:...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Interpret and analyze data from multiple sources including claims, provider, member, and encounters data. Identify and assess the business impact of trends Develop, maintain, and troubleshoot complex scripts and reports developed using SQL, Microsoft Excel, or other analytics tools Contribute to the planning and execution of large-scale projects with limited direction from leadership Assist in the design, testing, and implementation of process enhancements and identify opportunities for automation Identify and perform root-cause analysis of data irregularities and present findings and proposed solutions to leadership and/or customers Manage multiple, variable tasks...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Develop and create company written documents and communications and assist in the maintenance of an overarching marketing & communications practice. Collaborate with business partners as part of a multi-discipline communications team to develop messages for our employees Serve as a liaison between team members and cross-functional partners to ensure consistent messaging and timing Manage the internal communications editorial calendar to support our culture, align with our brand, and engage, inspire, inform and promote dialogue among our employees (an "internal reporter" mindset) Drive content planning and implement an editorial strategy for our organization's...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Business Systems Analyst identifies and presents business and technical specifications based on customer and business needs, industry best practices and available technology. Implements processes, systems and applications to meet the company's business initiatives. Responsible for driving low to moderately complex systems requirements (6 or less participants and/or budget of less than $200K). Consults with management and staff to identify and document business needs and objectives, current operational procedures, problems, input and output requirements, data scope, usage, formatting, and security requirements. Communicates the business requirements and technical...

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: This role is a business value multiplier, focused on maximizing business gains for every IT dollar invested. Create and own small features that support product strategy and IT delivery. Review/edit user stories and acceptance criteria to communicate clear product objectives and requirements Manage PI goals, work intake, backlog and schedules ensuring features are clearly described, estimated and prioritized Gather feedback from Developer teams and research industry trends to improve IT systems processes Collaborate with technical teams to build modular and reusable solutions, being a liaison between technical team and business/application owners Approve each feature...