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Assist with maximizing the effectiveness of scheduling, systems, performance metrics, data analysis, reporting and overall operational functions for all lines of business and all locations. Evaluate staffing adjustments and re skilling of agents as necessary to provide adequate phone coverage. Oversee and monitor real time call activity at various call centers and make necessary staffing adjustmen
Posted 1 day ago
Centene Corporation
- Columbia, SC / Sunrise, FL / Tampa, FL
Under direction, the Medicare National Agency Manager is responsible for sales in the assigned territory prospecting and closing new groups through assigned brokers and/or business partner relationships. Establishes and maintains business relationships as defined by Sales Management. Prospects and qualifies own leads, and manages prospect activity. Meets monthly and annual forecasted member and me
Posted 4 days ago
Centene Corporation
- Clayton, MO / Rancho Cordova, CA / Columbia, SC / 1 more...
This position will be responsible for supporting one or moreUM Digital initiatives. Thisentails being responsible for coordinating with other Product Owners, IT andothers associated with their assigned initiative. This position involves projects such as Digital initiatives to support increased provider web utilization. Responsible for ensuring the delivery ofexpected features/capabilities, to assi
Posted 23 days ago
Centene Corporation
- Columbia, SC / North Charleston, SC
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 options. Utilize knowledge, exp
Posted 1 month ago
Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with discharge planning, arrange transportation; provide
Posted 1 month ago
Authorize, direct and monitor care for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care Conduct peer reviews with psychologist and licensed therapist for outpatient and psychological testing requests Interact with network practitioners to provide education on best practice models
Posted 1 month ago
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, prognos
Posted 1 month ago
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines Track and trend overrides to
Posted 2 months ago
Medicare Sales Representative (South Carolina) Medicare Sales Representative (South Carolina) (1127037) Position Purpose Provide sales coverage and develop bestpossible market penetration for all products to present to prospective membersin assigned territory in accordance with company policies and programs. Providegreater access to health insurance , by providing education andassistance to Medica
Posted 2 months ago
Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess a
Posted 2 months ago
Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Direc
Posted 2 months ago
Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the strategic plan, establishing the strategic vision and attendant policies and procedures. Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determin
Posted 4 months ago
Perform provider data management related activities based on plan and contract specifications and standard business rules includes data analysis and entry, review of data via internet sites and other systems, and usage of multiple systems and applications to validate data is complete and accurate. Enroll providers and practitioners into the provider data management system Update provider and pract
Posted 4 months ago
Manage the compliance department functions, including but not limited to, periodic monitoring and auditing activities based on established compliance program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory, contractual and legal requirements. Manage approval and submission of timely and accurate contract and regulatory required report deliverabl
Posted 6 months ago
Perform duties to direct and coordinate the medical management, quality improvement and credentialing functions for the assigned health plan based on, and in support of the company's strategic plan; establishing the strategic vision and attendant policies and procedures. Direct and coordinate activities of department and aid the chief officer of the health plan and appropriate corporate staff in f
Posted 7 months ago
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