ProfessionalPosition Purpose: Responsible for developing and conducting a variety of training programs and auditing tools. • Conduct training
Ensure compliance with contract provisions with various agencies and applicable State and Federal laws • Serve as compliance resource for
Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process • Perform review of pharmacy and
Assist with aspects of the member’s care, including referrals to community resources
Knowledge, Skills and Abilities Demonstrated, or potential for, excellence in teaching, including both online and in-class health management and
Coordinate services with community based organizations. Attend marketing and outreach meetings as
Responsible for ongoing review of performance reporting and data, interpreting and prioritizing results and utilizing tools and resources
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will
Develop infrastructure and processes for management of activities related to National Committee for Quality Assurance (NCQA) Accreditation and
Responsible for ongoing review of performance reporting and data, interpreting and prioritizing results and utilizing tools and resources to identify
Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product Understand and apply all policies and
Position Purpose: • Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines
Coordinate urgent care evaluations when necessary. • Assist members with locating providers and
Maintain compliance with National Committee for Quality Assurance (NCQA) standards for utilization management functions for
Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals
Contribute to the development of new products and markets. • Utilize corporate and industry standard management tools and techniques to
Coordinate and communicate medical service functions with
This position will support the department’s growing educational and research programs and will be responsible for teaching, conducting high quality
Education/Experience: High school diploma or equivalent. 2 years of provider data or network administration
Empower patients to
Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve
Licenses/Certifications: Registered Respiratory Therapist (RRT) or Certified Respiratory Therapist (CRT) as recognized by the National Board
Position Purpose: Responsible for developing and conducting a variety of training programs and auditing tools. • Conduct training needs analyses
Facilitates the achievement of the Medical Management Program
Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system. Audit check run and send claims to
At least one year
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will
Coordinate services with community based organizations. Attend marketing and outreach meetings as
Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve
Facilitates the achievement of the Medical Management