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Medical Program Specialist

Little Rock, Arkansas Apply Now Job ID 1162618 Category Medical Management Organization AR Health & Wellness Schedule Full-time
Description:

Position Purpose: Responsible for analyzing various medical management programs that impact URAC/NCAQ. Conduct audits of various departments and modify/create training materials as necessary based on audit results.

  • Develop and modify processes, and conduct the assessment of/planning for programs that impact URAC/NCQA.
  • Conduct program analysis for variety of functions, and/or processes, with reporting on trends and overall metrics. Collection and analysis of data for any Corporate, or State, initiatives.
  • Audit various departments including the concurrent review team and outpatient case managers and various functions including Interqual reviews.
  • Develop and administer new hire Interqual testing process and remedial training programs. Responsible for maintenance of the training database records to ensure all training is reported and tracked.
  • Develop and train on the comprehensive discharge planning curriculum, with pre
  • and post
  • testing, for Medical Management department.

  • Qualifications:


    Education/Experience: Bachelor’s degree in related field or equivalent experience. 4+ years of related experience.

    License/Certification: LPN, RN, LPC, LMFT, LCSW, PhD or Pys.D required.

     

    *Experience with CMS Regulatory, JACHO, URAC, or NCQA Accreditation preferred.

    *Experience with policy and procedures and/or contract compliance preferred.



    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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