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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 2 days ago
Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts. Provide advanced analytical support for business operations in all or some of the following areas claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting Extract, load, model, and reconcile large amounts of data across multiple system pla
Posted 4 days 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, prognosi
Posted 5 days ago
Centene Corporation
- Clayton, MO / Harrisburg, PA / Woodland Hills, CA / 12 more...
Seeking Leaders Nationwide Seeking Leaders Nationwide (008UE) Centene is currently hiring director level leaders in a variety of departments nationwide! In a director role with Centene, you will make an immediate impact and remain at the forefront of enterprise wide growth and innovation. Forbes Magazine named Centene as the 27th fastest growing company, one of the top 25 companies that are changi
Posted 7 days ago
Centene Corporation
- Columbia, SC / North Charleston, SC
Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company's policies and programs. Provide greater access to health insurance, by providing education and assistance to Medicare individuals. Distribute health education materials and arrange for health screenings. Provide Facilitat
Posted 9 days 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. 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 assessment ski
Posted 9 days ago
TeleHealth Registered Nurse $2500 Signing Bonus, Various Shifts, Crisis Line, Bilingual Spanish preferred TeleHealth Registered Nurse $2500 Signing Bonus, Various Shifts, Crisis Line, Bilingual Spanish preferred (1081617) Position Purpose Triage inbound calls, gather information, select appropriate triage guidelines, and disposition and care advice based on data base protocols and department polic
Posted 10 days ago
Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams Implement and manage procedures for tracking, identifying and problem solving operational issues Interpret and present program results and develop data driven analysis and metrics used to measure effectiveness and ROI of all current and new products Act as the clinic
Posted 10 days ago
Identify special needs members through the completion of health screens and other resources Work with community outreach/member advocates to coordinate member care Educate providers and community resources on program components and available support services Educate members with special needs to foster compliance with program and positively impact outcomes Conduct site visits as appropriate for pr
Posted 15 days ago
Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with
Posted 15 days ago
Responsible for the auditing of systems entry, performance metrics and work processes for assigned function Compile audit findings and report to management, making recommendations for modifications and improvements to operations, systems and procedures Ensure defined goals are implemented and relevant analytics are available to measure goal performance Coordinate auditing outcomes to identify, dev
Posted 15 days ago
Provider Network Specialist II (Columbia, South Carolina) Provider Network Specialist II (Columbia, South Carolina) (1064458) Position Purpose Perform health plan provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network. Act as liaison between providers and the health plan to enhance the business relationshi
Posted 18 days ago
Operations Auditor II (Columbia, South Carolina) Operations Auditor II (Columbia, South Carolina) (1078434) Position Purpose Audit systems entry, performance metrics and work processes for assigned functions Audit accuracy of new group set ups, existing contract changes, group terminations Design, implement, and manage data review processes to ensure accuracy and integrity of PDM/Credentialing dat
Posted 18 days ago
Responsible for defining and directing a complete Case Management Program in conjunction with corporate goals and objectives Direct the overall operational leadership of case management functions and staff Perform and oversee needs analysis and planning Work with executive leadership to ensure targets are met for the annual operating plan/financial management Ensure compliance with Corporate, Stat
Posted 23 days 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 1 month ago
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