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Position Purpose: Responsible for participating in all phases of the financial system product lifecycle from business problem identification to solution deployment. Responsible for providing the primary functional and technical production support to end users of Centene financial
Position Purpose: Responsible for leading the Finance System Analyst team, overseeing daily operations, ensuring project alignment with business goals, and driving the overall direction of financial systems. Education/Experience: Bachelor's Degree in Finance, Accounting, Informa
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 educa
Position Purpose: Responsible for evaluating and interpreting Payment Integrity (PI) policies, Federal and State Regulatory, Contract changes to support compliant and accurate claims adjudication. Analyzes state and federal regulations, payer contractual requirements, and interna
Position Purpose: The Health Benefit Representative (HBR) is responsible for educating and assisting individuals with enrolling in affordable health insurance coverage through the NY State of Health Marketplace. This includes Medicaid (NYM), Child Health Plus (CHP), Essential Pla
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 s
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 educa
Position Purpose: Identify market trends and oversee functions of quality improvement programs for HEDIS, CAHPS, and/or HOS strategy and related quality improvement activities. Assists stakeholders to determine their business issues and recommend solutions to drive business value
Position Purpose: Collaborate with healthcare providers to help them achieve high performance with their value based contracts. 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
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
Position Purpose: The Coding Quality Coordinator II is the journey level position within a job series that performs complex reviews of clinical documentation on inpatient and outpatient medical records. Validates accuracy of diagnostic and procedural coding, payment methodology,
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: Support the development and maintenance of Risk Adjustment related programs and reporting. Aid in working with Risk Adjustment vendors for programs within all lines of business. Key Details: RN License, Clinical and/or Quality Improvement and HEDIS experience i
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 educa
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
The candidate will ideally reside in Austin or El Paso or surrounding areas. 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 ou
Position Purpose: Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. We are seeking curious, collaborative, and analytical students who are interested in using financial i
Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements. Key Details: This is a fully remote, wor
Position Purpose: Designs, develops and implements enterprise software solutions. Collaborates closely with technical and non-technical roles such as data modelers, architects, business analysts, data stewards, and subject matter experts (SMEs). Education/Experience: A Bachelor'
Position Purpose: Performs care management duties to assess, plan and coordinate aspects of medical and supporting services across the continuum of care for post-discharge members, promoting quality and cost effective care. Completes medication review for pre-admission and post-d