Fidelis Care Getzville, New York
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.
What does it take?
What are the qualities that will help you achieve success in this role at Centene?
- Good listener
Our Medical Roles
Clinical & Nursing Opportunities at Centene
Our Clinical team is at the forefront of our purpose-driven work. Learn more about how you can help transform the health of our communities, one person at a time.
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.
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.
You’ll use our data systems to directly assist providers, requesting services and treatments for our members.
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.
Category Clinical & Nursing
• Oversee the workflow and day-to-day operations of high risk case management and utilization management
functions, including implementation of policies and procedures
• Ensure compliance with established initial and concurrent review, case management, referral, pre-certification and authorization policies, procedures and processes
• Act as a liaison with other business units and facilitate on-going communications between case
management and utilization management staff, community agencies and contracted providers
• Provide oversight of telephonic review of inpatient admissions with doctors, hospitals, and other providers
• Monitor the effectiveness for existing outreach efforts and ensure appropriate knowledge/education and interventions are conducted for members defined to be at risk
• Analyze data to address trends or potential quality improvement opportunities including provider issues, service gaps and member needs
Position Purpose: Supervise and facilitate the daily operations of the case management and utilization management functions
Education/Experience: RN license or Master’s degree in Behavioral Health or related field. 3+ years of case and/or utilization management
experience. Experience in a psychiatric health care setting, including familiarity with mental health community resources. Working
knowledge of a specialized or technical field, such as clinical nursing, case and/or utilization management. Previous experience as a lead in
a functional area or managing cross functional teams on large scale projects.
License/Certification: Current state’s unrestricted license as a LCSW, LMFT, LMHC, LPC, PhD, PsyD or RN.
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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 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, Director, Business Implementation Health Plan Initiatives
Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.Honored to be Honored
Our Hiring Process
Learn more about our hiring process and discover other helpful information for applicants.Learn More
“Flexibility is key. Centene is a company of change.”
Started as a Referral Specialist, now a Project Manager IVSee Ashley's career path
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