centene

Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and thei

Position Purpose: **For use by Arizona, Superior, and Sunflower only.**Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote qualit

Position Purpose: **For use by Arizona, Superior, and Sunflower only.**Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote qualit

Position Purpose: Supports administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regu

Position Purpose: The Program Manager IV is responsible for all aspects of the planning and delivery of strategic programs and complex, large-scale enterprise-wide projects to execute defined requirements helping ensure appropriate coordination, visibility, and management of key risks and dependenci

Position Purpose: The Program Manager leads and supports strategic initiatives and ongoing operational priorities across Member and Provider Services. This role coordinates cross-functional stakeholders, manages risks and dependencies, and drives timely execution while maintaining established busine

Position Purpose: As a member of the Corporate Business Operations team, this role independently leads complex programs comprised of multiple projects and workstreams. The position is responsible for proactively identifying and mitigating risks, managing interdependencies, and driving alignment acro

Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and

Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education f

Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and

Position Purpose: The Case Auditor ensures accuracy, consistency, and compliance within care management operations by conducting comprehensive audits of case management activities, documentation, and processes. This role supports the organizations mission to deliver high-quality, member-centered car

This position is a field based role requiring the candidate to live in NJ. Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with

Position Purpose: Manages up-front third party evaluations and relationships with Delegation partners for performance management standards, financial responsibility and proactively implements appropriate business solutions as required. Acts as the critical link between our Delegation partners and in

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate

Position Purpose: This role serves as a trusted advisor to leaders and employees across the enterprise, providing guidance and support on a wide range of workplace matters while helping ensure fair, consistent, and compliant employment practices. The People Relations (PR) Partner manages employee re

Position Purpose: Support strategies to ensure successful maintenance and implementation of compliance programs that meet regulatory requirements for assigned products across the entire company. Key Details: Applicants for this job have the flexibility to work remote from home anywhere in the Contin

Position Purpose: Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/careg

Position Purpose: Develops and implements effective business solutions through research, audit, and analysis of data and/or business processes. Audits and validates routine pre and post payment claims to determine correct adjudication as well as compliance with corporate policies and procedures, and

Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote qu

Position Purpose: Responsible for clinical file assessments. Identifies monthly insights for improvement and participates in Interrater Reliability meetings. Aids in efforts to continuously develop review tools to ensure validity of criteria, and appropriately captures evidence of expected clinical