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Position Purpose: Provides technical support to ensure the proper and effective use of clinical information systems and improve the delivery of patient care. Assists users with system navigation, troubleshooting and patient monitoring issues. Collaborates with leaders across func
Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Key Details: This fully remote role supports
Position Purpose: Manages the team members accountable for designing, developing, and implementing complex enterprise software solutions. Collaborates closely with technical and non-technical roles such as data modelers, architects, business analysts, data stewards, and subject m
Position Purpose: Strategizes, plans, conceptualizes, configures, and builds complex solutions that solve common challenges within the business, by using technological tools or programs. Conducts extensive research and gathers requirements to determine customer needs and lead and
Position Purpose: Provides comprehensive support to Fidelis and Wellcare members by addressing inquiries, conducting outreach, and assisting with enrollment in various health plans, including Medicaid, Medicare, and other Fidelis Care products. This role requires in-depth product
Position Purpose: Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care Key Details: Make an impact from home as a Remo
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Key Details:
Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephoni
Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Key Details: This
Position Purpose: Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or i
Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Key Details: This
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
Position Purpose: Provides comprehensive support to Fidelis and Wellcare members by addressing inquiries, conducting outreach, and assisting with enrollment in various health plans, including Medicaid, Medicare, and other Fidelis Care products. This role requires in-depth product
Position Purpose: Work with the Pharmacists to accurately prepare prescription orders in a timely manner Key Details: Pharmacy Technician II (Specialty Fulfillment - Onsite Mail-order) - Hawthorn, NY. This position is based at Centene's Acaria Health Pharmacy, located at 5 Skyli
Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends/schemes Education/Experience: Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent
Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Education/Experie
Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. KEY DETAILS: This fully remote role with “Pa
Position Purpose: Plays a critical role in advancing Data Loss Prevention (DLP) program maturity by contributing to strategy, guiding solution design, and reducing enterprise data loss risk. Operates with a high degree of independence, discretion, and professional judgment. Appli
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 and meet company strategic objectives. This role provides leadership, direc
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Education/Exp