Description
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
**Must live in Oklahoma**
Oklahoma Complete Health, a Centene company, is committed to providing quality healthcare solutions to transform the health of Oklahomans.
At Oklahoma Complete Health, we are community advocates and change-makers in search of an inclusive culture grounded by our commitment to work-life balance, competitive compensation, and continuous career development. Join us and be a part of a collaborative, growing network of innovative thinkers delivering solutions at the local level.
Position Purpose: Perform collaborative duties for the development and implementation of all Coordinated Care programs (OB/NICU, Asthma, Diabetes, ER, General/Catastrophic); Provide support and supervision to ensure quality and continuity of services delivered to Members, Providers and staff.
- Develop and oversee aspects of coordinated care program activities
- Develop and implement management software and reporting mechanisms for specific outcome measurement and data reporting
- Identify referrals for coordinated care programs.
- Develop plan specific literature and educational components for member and provider distribution.
- Oversee contract negotiation and execution components for Prenatal Coordinated Care (PNCC) entities
- Collaborate with various departments to extract data for identification of program members and to report program outcomes
- Identify processes and work flow improvements to foster efficient and effective case management efforts
- Monitor distribution of members identified for case management to ensure positive results and program success
Education/Experience: High school diploma or equivalent. 5+ years of prior authorization, physician's office, customer service, claims processing or provider relations experience preferably in a managed care setting. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.
For Oklahoma Complete Health only:
Children Specialty Plan: Substantial knowledge about the complex care needs of the populations served, particularly children adjudicated, deprived, and in custody of the Oklahoma Human Services (OHS) and Oklahoma Office of Juvenile Affairs (OJA), and/or Oklahoma’s child welfare or juvenile justice system through formal education, personal, or employment experience.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
