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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 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 1 day ago
Pharmacy Coordinator II Pharmacy Coordinator II (1198604) Analyze pharmacy authorization criteria, and help to reword them in patient friendly language suitable for member communication, while maintaining specificity and meaning of the original requirement. Assist in maintenance of member letter templates in line with state and plan guidelines, as well as NCQA standards. Perform duties to support
Posted 1 day ago
Centene Corporation
- Clayton, MO / Tempe, AZ / Tampa, FL / 1 more...
Oversee and all aspects of the patient care and reimbursement teams with operational, quality, safety and service standards as priority. This individual serves as a liaison between their teams, senior management, and healthcare clients to encourage growth and promotion towards complete customer satisfaction. Works across the organization to ensure patient, caregiver, and customer needs are met. Pr
Posted 2 days 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 days ago
Centene Corporation
- Atlanta, GA / Tampa, FL / Tempe, AZ / 1 more...
Assist in financial analysis, pricing and risk assessment to estimate outcomes. Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes Demonstrate analytical and technical skills Demonstrate interpersonal/verbal communication skills Demonstrate written communication skills Ability to analyze, model and interpret financial data An
Posted 2 days ago
Compile and analyze financial information for the company. Lead various financial projects. Cost effectively manage the utilization of services and develop measures to track, trend and forecast related impacts of organizational strategic initiatives. Run pre established reports as well as development of new reports for internal stakeholders and regulatory agencies Develop metrics to evaluate finan
Posted 3 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 4 days ago
Centene Corporation
- Tempe, AZ / Tucson, AZ
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 5 days ago
Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD 9/10 CPT coding in accordance with state, federal, and NCQA requirements. Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap cl
Posted 5 days ago
Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed. Verify eligibility and benefits Answer phone queues and process faxes within established standard
Posted 8 days ago
Provides behavioral health care management services through prospective, concurrent and retrospective evaluation and review of treatment. Determines medical necessity, level of care required and quality of care provided. Coordinates and manages behavioral health services rendered by network and non network providers to health plan members using InterQual criteria, clinical skills and expertise, pe
Posted 8 days ago
Oversee the day to day work functions of the assigned area, provide support to staff and exercise cost control in order to accurately and timely process members' medical claims. Hire, inspire, motivate, coach, counsel and supervise staff. Monitor performance of employees Assess and allocate work volumes on a daily basis. Special project work as assigned. Ensure task completion and performance goal
Posted 10 days ago
Perform various analysis and interpretation to link business needs and objectives for assigned function. Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems Identify and analyze user requirements, procedures, and problems to improve existing processes Perform detailed analysis on multiple projects, recommend p
Posted 10 days ago
The Pharmacy Technician may perform duties in one or more of the following areas Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center or Prior Authorization, Medicare Part D Operations and State Health Programs Pharmacy Operations. Formulary Management Reviews and processes formulary change requests from Health Net plans Submits and maintains formulary change requests to Heal
Posted 11 days ago
Qualifications Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Posted 11 days ago
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