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Manager, Referral Services

Centene Corporation Tempe, Arizona

As part of the Customer Service department, you’ll use your knowledge of Centene’s insurance products and service to help our members understand their benefits, details and policy procedures. With your skills, you can help transform the health of every community, 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
  • Organized
  • Proactive
  • Positive
  • Trustworthy
  • Consistent

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Our Customer Service Roles

Customer Care Opportunities at Centene

Our Customer Service teams work to ensure high levels of service and customer satisfaction. Learn more about this vital group at Centene

Claims Analyst

As part of a tight-knit team and working as a partner to each provider, you’ll evaluate the needs of your health plan and process all claims in accordance with guidelines.

Claims Liaisons

While ensuring that provider and member requests are taken care of, you’ll review requests from providers and work with state health plans to ensure the accuracy and quality of claims.

Customer Service Representative

You’ll use your healthcare knowledge, analytical skills and our information resources to quickly and correctly answer questions from members and providers.

Enrollment Analyst

You’ll process incoming membership files and focus on maintaining the enrollment integrity of our individual health plan systems.

Systems Solutions Manager

While leading a team of business analysts, you’ll work with the IT department to drive end-to-end solutions for core applications supporting Centene’s operations. Claims Analyst.

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Responsibilities

Job ID 1157540

Category Customer Service
Schedule Full-time
Description:
Position Purpose: Conduct and manage the day to day operations of the referral specialist department. Communicate with staff to facilitate daily department functions. Create a vision for the department and determine future needs.

  • Develop, implement, and maintain utilization management programs to facilitate the use of appropriate medical resources and decrease financial exposure.
  • Ensure that standards as defined by accrediting agencies and State contract are maintained.
  • Ensure compliance with federal and state regulations and contractual agreements.
  • Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions.
  • Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives.
  • Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management.
  • Facilitate on
  • going communication between utilization management staff and contracted providers.
  • Qualifications:

    Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ years of utilization management and Medicare and/or Medicaid insurance experience. Working knowledge of Medicare and Medicaid managed care practices and policies and State Children's Health Insurance Program (SCHIP). Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

    License/Certification: Certain Health Plans may require Registered Nurse with current state 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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    Quote

    “Centene has been instrumental in my professional development. I’m pushed in a way that challenges my fears, improve my skills, and enhance my knowledge on healthcare.”

    - Meaghan Hooks, Business Analyst II

    “My job has a direct impact on our providers and members. With every claim paid out the door we are directly helping to save someone’s life!”

    - Jonelle Levy, Business Analyst II

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    Our Awards

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

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    Our Hiring Process

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

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    “Centene is an exciting company to work for.”

    Esmeralda Baig

    Started as a Case Manager, now a Senior Vice President of Operation

    See Esmeralda's career path

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