87025 Centene jobs found in New York, NY

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: Oversee a full range of waste, abuse and fraud investigations, audits and medical code editing scenarios. Ensure all audits adhere to federal and state Medicaid fraud, waste and abuse guidelines. Oversee the activities of the SIU for accurate and timely operational reviews and final reviews Interpret audit results and assist health plan executives in the development of appropriate action plans to address identified risks Develop and implement continuous auditing processes from analytic design to final report stage Identify and direct the implementation of new technologies Ensure compliance with all state and federal regulations for fraud and abuse Respond to all legal...

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. Must reside in Somerset and Middlesex County NJ Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders Coordinates as appropriate between the member and/or family/caregivers,...

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. Must reside in Bergen and/ or Hudson County NJ Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate...

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. Must reside in Hudson County NJ Conduct home visit(s) to educate applicant, family and/or applicant’s caregiver(s) or newly enrolled LTSS members on program benefits and design. Identify applicant’s health needs and complete medical assessment of applicant. Utilize WellCare designated criteria along with clinical knowledge to develop personalized plan of care. Initiate direct communication with health care providers involved in the care of the applicant to obtain complete and accurate information needed to complete plan of care. Negotiate appropriate care plan based on health assessments with health care providers, member and caregiver. Collect information concerning eligibility, provider status,...

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. Must reside in NJ Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs Provides resource support to members and care managers for local resources for various services (e.g.,...

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. Must reside in Bergen and/or Passaic County NJ Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate...

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. Must reside in NJ Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care...

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. Must reside in Somerset and Middlesex County NJ Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders Coordinates as appropriate between the member and/or family/caregivers,...

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. Must reside in Hudson County NJ Conduct home visit(s) to educate applicant, family and/or applicant’s caregiver(s) or newly enrolled LTSS members on program benefits and design. Identify applicant’s health needs and complete medical assessment of applicant. Utilize WellCare designated criteria along with clinical knowledge to develop personalized plan of care. Initiate direct communication with health care providers involved in the care of the applicant to obtain complete and accurate information needed to complete plan of care. Negotiate appropriate care plan based on health assessments with health care providers, member and caregiver. Collect information concerning eligibility, provider status,...

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. Must reside in NJ Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs Provides resource support to members and care managers for local resources for various services (e.g.,...

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. Must reside in Bergen and/or Passaic County NJ Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate...

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. Must reside in NJ Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care...

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. Must reside in Bergen and/ or Hudson County NJ Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate...

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: Bilingual English/Chinese, Korean, or Japanese Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company's policies and programs. Provide greater access to health insurance, by providing education and assistance to Medicare individuals. Distribute health education materials and arrange for health screenings. Provide Facilitated Enrollment, help facilitate the continuance of health insurance, and offer assistance with recertification. Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product Understand...

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: Provides safe operation, regular upkeep, and maintenance of Community Outreach Vehicles (COV) and other company vehicles to support organizational marketing efforts; represents Fidelis Care New York at various community events and marketing sites. Adhere to safety systems, policies, plans, and procedures to ensure a safe working environment; responsible for the safe operations of the transportation vehicles and equipment including obeying and understanding all laws and traffic ordinances. Maintain assigned vehicles regularly; perform mechanical troubleshooting, upkeep, and overall cleanliness maintenance to ensure that vehicles are safe for full operation; call for...

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. Must reside in Somerset and Middlesex County NJ Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders Coordinates as appropriate between the member and/or family/caregivers,...

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. Must reside in Bergen and/ or Hudson County NJ Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate...

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. Must reside in Hudson County NJ Conduct home visit(s) to educate applicant, family and/or applicant’s caregiver(s) or newly enrolled LTSS members on program benefits and design. Identify applicant’s health needs and complete medical assessment of applicant. Utilize WellCare designated criteria along with clinical knowledge to develop personalized plan of care. Initiate direct communication with health care providers involved in the care of the applicant to obtain complete and accurate information needed to complete plan of care. Negotiate appropriate care plan based on health assessments with health care providers, member and caregiver. Collect information concerning eligibility, provider status,...

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. Must reside in NJ Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs Provides resource support to members and care managers for local resources for various services (e.g.,...

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. Must reside in Bergen and/or Passaic County NJ Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate...