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Program Specialist -Medical Management

Superior HealthPlan Austin, Texas

As a member of the Centene Medical Management/Health Services team, you’ll help innovate and execute strategies that redefine the industry standard for improving the lives and health of people. We’re a team of skilled physicians, nurses, pharmacists, social workers and health service experts who use our advanced clinical analytics to implement award winning programs, develop care, deliver partnerships, and work directly with our members to achieve outcomes that set us apart as industry leaders. Together, we’re transforming the health of communities, one person at a time.

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What does it take?

What are the qualities that will help you achieve success in this role at Centene?

Success Profile

  • Detail-oriented
  • Trustworthy
  • Personable
  • Quick-thinking
  • Multi-tasker
  • Good listener

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“Centene is an exciting company to work for, the pace at which we’re growing allows numerous advancement opportunities. Also, we foster an environment that supports and offers numerous leadership growth opportunities.”

- Esmeralda Baig, SVP Operations, Complex Care Products

“I enjoy the people and the flexibility of my role. As an onsite nurse, I have the pleasure of working with my team at Centene as well as the wonderful team at my onsite hospital.”

- Njeri Young, RN, Concurrent Review Nurse

“I assisted with one of the Provider fairs in the community. Seeing how much we care for our community and our patients was very eye opening.”

- Julie Boulch, Senior Manager of Medical Management Operations

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Job ID 1125632

Category Clinical & Nursing
Schedule Full-time
Position Purpose: Assist the Director Medical Management with auditing, training, data analysis, program and policy development for the medical management team for the entire Plan.

  • Analyze turn around times of assigned tasks for medical management team, work loads, and reports
  • Audit medical management cases to ensure compliance with designed programs and timeliness
  • Develop and update policies and procedures to maintain alignment with current processes and articulate best practices in the industry
  • Design programs to manage work loads and maintain performance standard and implement effective work functions
  • Train medical management staff on new processes & procedures and systems
  • Provide ongoing technical support to new and existing staff on systems, regulatory requirements, customer service, and other areas as needed
  • Assist in prior authorization inventory
  • Assist with provisions of Medicare Advantage Prescription Drug coverage and services
  • Qualifications:

    Education/Experience: Nursing degree in related field. 4+ years of medical management or related experience. Bilingual skills (Spanish) are preferred.

    License/Certification: LPN, LVN, or RN license.

    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.
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    Our Medical Roles

    Overall Medical Management

    A member of the Centene Medical Management team, we innovate and execute strategies that redefine the industry standard for improving the lives and health of people.

    Concurrent Review Nurse

    To ensure our members get the best quality of care, you’ll assess acute member health conditions, treatment and intervention options, and match them with providers, community and health plan resources.

    Prior Authorization Nurse

    You’ll ensure our members get the best quality services, assistive devices, and equipment to promote optimal health and independence in the community and help promote health and independence.

    Care Manager

    Working directly with members, interdisciplinary care team, providers and data analytics, you’ll identify member health risks and conditions and intervention and service options.

    LTSS Program Specialist/Program Specialist Field Based

    Working directly with our most vulnerable members, you’ll identify individual member health risks and opportunities to enhance independence, quality of life and community engagement.

    Referral Specialist

    You’ll use our data systems to directly assist providers, requesting services and treatments for our members.

    Medical Director

    To help support the individual needs of members and develop programs that address issues, you’ll review population health data, help design clinical programs, and develop care delivery partnerships.

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    Our Awards

    Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.

    Honored to be Honored

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    Our Hiring Process

    Learn more about our hiring process and discover other helpful information for applicants.

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    “Flexibility is key. Centene is a company of change.”

    Ashley Collier

    Started as a Referral Specialist, now a Project Manager IV

    See Ashley's career path

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    • Clinical & Nursing, Austin, Texas, United StatesRemove

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