Centene Corporation jobs

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 p...

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 p...

Clinical Appeals Coordinator (Behavioral Health)

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 regar...

Clinical Extern

Position Purpose:Develop clinical knowledge and skills by learning about various processes and functions within the Managed Care industryObserve processes and shadow preceptors to gain hands on experience and become familiar with various clinical servicesFollow instructions and procedures provided by preceptor or manager in accordance with company guidelines Observe preceptors and participate in various projects to learn and develop skills related to the Managed Care industry.Education/Experi...

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, participa...

Case Manager II

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.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 optionsUtilize assessment skills and discretionary judgment to develop plan of care based upon assessment with...

Clinical Appeals Coordinator (Behavioral Health)

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 regar...

Clinical Appeals Coordinator (Behavioral Health)

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 regar...

Case Manager I

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 Coordinate ...

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...
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