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Position Purpose: Conduct analysis, pricing, and risk assessment to estimate financial outcomes while supporting the Risk Adjustment team through data analytics, risk adjustment modeling, and complex data validation initiatives. Key Details: Candidates must have either 7+ years
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: The Public Programs Coordinator is responsible for triaging and resolving member access to care issues and coordinating services with programs that are "carved out" of the health plan contract with the Department of Health Care Services, i.e. California Children
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: 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: 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: 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: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. - Provides medical leadership of all for utilization management, cost containment, and medical quality impr
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their fami
Position Purpose: Lead external relations activities in Kansas in accordance with Centene, health plan, government, and contractual guidelines. Develop and maintain relationships with legislators, county governments, associations, and other key stakeholders to monitor, influence,
Position Purpose: Provide strategic and operational insights to senior leadership to drive the key initiatives and growth plans in the market. Collaborate with Corporate Strategy partners to ensure alignment with broader organizational Initiatives. Act as a key resource for infor
The Care Manager will be responsible for enrolling members in case management and completing required care management activities for individuals of all ages. The role requires strong communication, organization, and care coordination skills to ensure members receive appropriate s
Position Purpose: Audit medical records to identify inappropriate billing practices and recommend next steps through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards. Key Details: Preferred qualifications include co
Position Purpose: Ensure regulatory compliance with Washington state and other government agencies related to the health insurance industry, Centene Corporation, and its business subsidiaries. Key Details: Candidates must reside in the state of Washington and be willing to trave
Position Purpose: Conduct strategic analysis, peer review, build and support tools to aid in planning processes, pricing, and assess risk to estimate financial outcomes. Provide expertise and technical support in matters related to the successful and financially sound operations
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: Conduct strategic analysis, pricing, peer review, build and support tools to aid in planning processes and assessing risk to estimate financial outcomes. Manage actuarial needs and produce actuarial reports to aid in developing corporate strategy. Key Details:
Position Purpose: Provide consultative support to providers to improve their performance on member outreach, utilization management, cost, quality and risk. Discuss, analyze and interpret performance reporting, member engagement data and other data resources to identify opportuni
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
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