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Position Purpose: Develops, assesses and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes. Evaluates member service needs and
Position Purpose: Works with the utilization management team and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline Documents some complex authorization requests and obtain accurate and tim
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: 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: Develops, assess and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes. Evaluates member service needs and de
Postition Purpose: Manages a team responsible for facilitation and leading external audits related to Risk Adjustment processes. Ensures visibility by way of reporting out audit deliverables and associated risk related for each audit. Collaborates with business areas to ensure ef
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: Provides on-site and remote technical support to end users and site IT infrastructure (including network, print, audio/video and office setup) by troubleshooting hardware and software problems. Analyzes events and applies technical knowledge following establishe
Position Purpose: Manage the business processes related to risk adjustment and quality improvement across Centene’s for assigned products and plans. Key Details: Ideal candidate to live in the state of PA. - Develop and implement action plans, across all departments affecting a
Position Purpose: Create, review, and approve home modification requests managing all aspects of the process while ensuring waiver and contract requirements are met. Key details: Candidates must live in Ohio within one of the following counties: Cuyahoga, Lorain, Medina, Summit,
Position Purpose: Manage assigned functional area (filing submissions; state legislative/regulatory interpretation and policy research; development of member materials or QHP templates, and/or product benefit database). Responsible for quality of their functional area outputs. Re
Position Purpose: Provides on-site and remote technical support to end users and site IT infrastructure (including network, print, audio/video and office setup) by troubleshooting hardware and software problems. Analyzes events and applies technical knowledge following establishe
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: 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: Develops, assesses and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes. Evaluates member service needs and
Position Purpose: 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
Position Purpose: 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
Position Purpose: 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
The Business Solutions Developer III is responsible for designing, developing, implementing, and supporting business-managed applications, automations, data solutions, and reporting capabilities that address complex operational needs. This position serves as a technical subject m
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, or CPT. Posi