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.
Hybrid Position - Remote and Field
Must Reside and be Licensed in Texas
RN or LPC Preferred - SDA - Bexar County
Position Purpose: Ensure the timely and safe transition of members into or out of the health plan. Assist in the transition of members back into the community from various levels of health care services.
- Manage the transition of care for members enrolling or exiting the health plan
- Identify new enrollee requiring transition of care services
- Complete assessment of the new Enrollee’s health care needs
- Determine the presence of active care needs or possible outstanding service authorizations
- Identify the Enrollee’s previous MCO (if applicable)
- Contact the previous MCO and/or Primary Care Provider (PCP) to obtain relevant Enrollee information (if applicable)
- Ensure existing authorizations with previous health plan or in fee-for-service are honored during the transition, for a minimum of 60 calendar days from the date of enrollment in the health plan
- Assist the enrollee with continuing authorization of medically necessary services, transitions into Integrated Care Program, transitions between MCOs, and transitions to private insurance or no coverage.
- Coordinate care plans with community care coordinators and the enrollee
- Educate transitioning enrollees about services, requirements, limitations and/or exclusions of services as a result of the transition.
Education/Experience: Bachelor’s degree in Social Work, Nursing, Health, Behavioral Science or equivalent experience. 3+ years of related experience. Experience working with Medicaid recipients with physical, developmental and intellectual disabilities and/or behavioral health conditions. Experience in insurance and utilization review.
License/Certification: Valid driver's license. Social Worker, LPN, LVN, or RN preferred.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
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.