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SalaryYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
This is a remote position. Hours are 8:00-5:00 pm. Candidate must reside in TX
Position Purpose: Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care
- Assists with developing workflows and daily assignments for staff
- Serve as a resource and help resolve complex issues
- Initiate authorization requests for output or input services in keeping with the prior authorization list.
- Maintain working relationships with other departments
- Research complex claims inquiries specific to the department and responsibility
- Attend ongoing training and in-services
- Promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census
- Screen for eligibility and benefits and identify members without a PCP and refer to Member Services.
- Coordinates services with community based organizations.
- Assist with developing marketing and outreach meetings
- Produces CM letters and program educational materials
- Train new staff on systems , usage, benefits, authorization requirements and policies and procedures
- Maintains databases and data enters assessments and authorizations into the system.
Education/Experience: High school diploma or equivalent. Bachelor’s degree preferred. 3+ years of managed care or physician’s office experience. Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment. Previous experience operating office equipment such as a personal computer. Knowledge of medical terminology.
License/Certification: LPN license highly preferred.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
