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Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner. Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources Provide assistance to members and/or providers regarding website registration and navigation Document all activiti
Posted 2 days ago
Director, Network Operations (1157683) Position Purpose Oversee all network management related activities for existing providers ensuring the business unit is meeting state and customer required network standards for accessibility and availability. Collaborate with existing providers to improve clinical effectiveness and achieve the best possible outcomes for members Oversee network management tea
Posted 3 days ago
Conduct analysis, pricing and risk assessment to estimate financial outcomes. Manage health plan specific actuarial needs and produce actuarial reports to aid in developing corporate strategy. Serve as the main point of contact for all actuarial related activities for an assigned health plan Manage at least 1 health plan Apply knowledge of mathematics, probability, statistics, principles of financ
Posted 11 days ago
Program Coordinator II (1152417) Position Purpose Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Maintain integrity of PHI. Maintain working relationships with other departments. Research claims inquiry specific to t
Posted 1 month ago
Behavioral Case Manager, LPC/LCSW (1152403) Position Purpose Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members' current functional level and, in collaborat
Posted 1 month ago
Manager, Risk Adjustment (1147674) Position Purpose Manage the business processes related to risk adjustment and quality improvement across Centene's for assigned products and plans. Develop and implement action plans, across all departments affecting assigned products and plans, to address issues identified by the business units, including detailed workplans, issue logs, and progress reports Iden
Posted 2 months ago
The Clinical Trainer for the Medical Management department is responsible for developing and conducting a variety of training and training audit programs and related tools. Conduct training needs analyses to determine specific training and auditing needs for Medical Management department staff Identify, develop and conduct appropriate training programs, including selecting and designing appropriat
Posted 2 months ago
Quality Improvement Coordinator HEDIS RN (1147393) Position Purpose Analyze, develop, implement and monitor clinical quality improvement initiatives to achieve healthy outcomes. Perform duties and functions to comply with quality improvement programs according to state requirements. Support Quality Assurance Performance Improvement work plan/initiatives. Schedule and assist with committee and sub
Posted 3 months ago
Behavioral Case Manager (1144988) Position Purpose Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members' current functional level and, in collaboration with t
Posted 3 months ago
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