Centene Corporation jobs

Clinical Provider Trainer- Long Term Care, BH

Position Purpose: Develop and implement trainings to educate network providers and their staff on the company's clinical philosophy and evidence-based practice methods. Collaborate with other staff, departments and health plan staff for maintaining and monitoring the delivery and effectiveness of the training program and identify solutions to challenges. Minimum of 50% travel required. Develop and provide formal provider staff training. Develop and maintain outreach program member materials...

Behavioral Case Manager

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...

Clinical Program Manager ** Clinical Licensed Required **

Description:Position Purpose//: The Clinical Program Manager is responsible for identifying, managing and tracking clinical, quality, correct coding, documentation and data submission projects that advance the objectives of Health Net s strategic goals. The Clinical Program Manager facilitates the development of internal and external reports and the delivery of data as needed to support and monitor the action plans to accomplish the Triple Aim//: 1) to improve member experience, 2) improve th...

Clinical Educator

Position Purpose: Develop and educate clinical staff on the company's clinical philosophy and evidence based practice methods required for excellent patient outcomes and regulatory requirements. Develop and facilitate new hire orientation for the clinical staff and ensure transition of training into daily work activities related to clinical practice, patient safety and evidence-based practice Assess plans, develop and deliver clinical curriculum, developmental programs and services to assist ...

Clinical Appeals Coordinator

Description: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 criteriaGather, analyze and report verbal and written informati...

Transplant & Catastrophic Case Management Coord

Position Purpose: Responsible for the management of transplant and large dollar cases and oversight including compilation of clinical information, coordination of internal/external review and approvals, coordination with stop loss vendor, assisting with contract assignment and/or assignment to the approved transplant center, case monitoring, ongoing communication with transplant facility and the Plan's assigned case manager, medical director, and organization finance department. Coordinate tr...

Behavioral Case Manager

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 ...

Case Manager I

Pipeline - GeneralPosition Purpose: Perform caremanagement duties to assess, plan and coordinate all aspects of medical andsupporting services across the continuum of care for select members to promotequality, cost effective care.Develop, assess andadjust, as necessary, the care plan and promote desiredoutcomeAssess the member'scurrent health status, resource utilization, past and present treatment plan andservices, prognosis, short and long term goals, treatment and provideroptionsCoordinate...

Manager, Case Management

Description:Position Purpose//: Perform duties to conduct and manage the day to day operations of the case management functions communicating with departmental and plan administrative staff to facilitate daily department functions.Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes.Promote compliance with federal and state regulations and contractual agreements.Develop, implement and maintain complianc...

Supervisor, Case Management

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, procedures and proc...
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