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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 quality, cost effective care. Develops a personalized car
Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT,
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: Ensure regulatory compliance with state and other government agencies related to Health Net, Centene Corporation, and its business subsidiaries. Key Details: Applicants for this role must live in the state of California. - Bachelor's Degree in Public Policy, G
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: Partners with either Health Plans or Shared Services to translate privacy, security, artificial intelligence (AI), business continuity, and related requirements from client contracts, laws, and regulations into actionable enterprise controls. Builds trusted rela
Pharmacy Technician II (Onsite Specialty Outreach - Customer Service - Phone Outreach with Data Entry) - Houston, TX - - Customer service-focused pharmacy technician role, with phone work making up 90% of the shift - Comfortable handling phone calls and data entry with a pos
Position Purpose: Recruit physician, hospital and ancillary service providers to sign network participation agreements that are in accordance with Corporate, health plan and State guidelines. Ensure that all necessary documentation and information are included. Key Details: Must
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 medica
Note: This is a fully remote role with Central time (CST) working hours along with 10% travel. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportu
Position Purpose: Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Key Details: Current state's Pharmacy Technician license strongly preferred. Education/Experience: High school dip
Position Purpose: Collaborate with courts, county administrators, providers, law enforcement, and other system partners to implement coordinated and effective judicial processes impacting enrolled members. Must be authorized to work in the U.S. without the need for employment-ba
Position Purpose: Provide clinical expertise to clients in designing benefits/clinical programs to optimize therapeutic outcomes while maintaining economic efficiency in the delivery of medication therapy. Interface with external clients and marketing staff to facilitate the deve
- Monitors and investigates all quality of care concerns and collaborates with medical director to determine impact and next steps for actions. - Monitors provider quality complaints to identify trends and educational opportunities for improvement. - Monitors quality improvemen
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 quality, cost effective care. Develops a personalized car
Position Purpose: Provide solutions to attain key performance improvements and reduce risk for assigned product lines across multiple lines of business. Work across functional business areas to identify, analyze and develop product solutions to daily problems and initiatives. -
Position Purpose: Supports community connection activities including connecting members to community resources to support their care management journey and provide necessary care resources in a cost-effective manner. Provides members with known community resources and supports th
Position Purpose: Supports the goals and outcomes of the organization by leading the transformation of our business strategy. Ensures deliverables are met, by assisting with design, execution, and value estimation and realization for initiatives. Education/Experience: Bachelor's
Position Purpose: The position is responsible for providing leadership and direction for clinical, quality, and risk adjustment functions. Execute on the development and oversight of clinical programs for physician education and communication as well as development of their team
***NOTE: This is a fully remote role*** Position Purpose: Coordinate and monitor quality improvement and organizational projects from inception to closure including National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set (HEDIS) prep