Centene Corporation jobs

Member Advocate II

Position Purpose: Act as an advocate for members and a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Establish a community presence, promote member education, identify and resolve any systemic barriers that limit access to appropriate care. Receive and respond to member complaints and formal grievances and identify potential access barriers and resolve as indicated in the grievance procedure. Serve as primary contact and liaison between member advo...

Clinical Appeals Coordinator

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. Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested. Prepare reviews for cases that did not meet criteria Gather, analyze and report verbal and written information regardin...

Member Connections Representative II

Position Purpose: Assist the health plan in establishing a presence in the community through home visits and community outreach. Serve as the lead for new Member Connections Representatives, including training and attending home visits with the Representatives Assist with developing and communicating the daily schedules and routes of assigned home visits with MapPoint Identify potential high risk members and reach out to case managers for possible outreach attempts Enter and maintain team pro...

Case Manager RNCC

Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. * Develop, assess and adjust, as necessary, the care plan and promote desired outcome * Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options * Coordina...

Behavioral Case Mgr – PASRR/LOCUS

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 the member, develop and monitor the Case Management Care Plan, monitor quality of care; assisting with discharge planning, particip...

Member Connections Representative II

Position Purpose: Assist the health plan in establishing a presence in the community through home visits and community outreach. Serve as the lead for new Member Connections Representatives, including training and attending home visits with the Representatives Assist with developing and communicating the daily schedules and routes of assigned home visits with MapPoint Identify potential high risk members and reach out to case managers for possible outreach attempts Enter and maintain team...

Clinical Adherence Specialist

Description:Position Purpose\: Conduct telephonic adherence assessments and provide interventions per program guidelines.Conduct and complete telephonic assessments, identify adherence risk, and collect relevant health information from patientsEstablish ongoing coaching relationship with assigned patients throughout duration of participation in the programEducate providers, case managers and community resources on program components and available support servicesCollaborate with providers to ...

Supervisor, Case Management (RN)

Description:Position Purpose\: Supervise the day to day operations of the case management function. Communicate with departmental and plan administrative staff to facilitate daily department functions.Assure compliance with established referral, pre-certification and authorization policies, procedures and processes by related Medical Services staff.Assure compliance with established onsite and concurrent review, case management, referral, pre-certification and authorization policies, procedur...

Supervisor, Case Management

Description:Position Purpose\: Supervise the day to day operations of the case management function. Communicate with departmental and plan administrative staff to facilitate daily department functions.Assure compliance with established referral, pre-certification and authorization policies, procedures and processes by related Medical Services staff.Assure compliance with established onsite and concurrent review, case management, referral, pre-certification and authorization policies, procedur...

Behavioral Case Mgr

Description: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 the member, develop and monitor the Case Management Care Plan, monitor quality of care; assisting with discharge planni...
  • 1
  • 2
© 2018 National Council of Nonprofits powered by Careerleaf
v.3.1.1