Description
Position Purpose: Works with care management team on administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines.
Key Details: Successful candidates in this role: are critical thinkers, organized, action-oriented, have strong communication skills (verbal and written), flexible with business needs, quick learners, comfortable presenting findings and data to People Leaders and peers, and works well under pressure to handle escalations and tight deadlines.
NOTE: This role assists People Leaders with data reporting on a weekly basis (up to 50%) and will need to have moderately strong Excel skills (i.e. data extraction, creating pivot tables, conditional formatting, etc) and/or curious to learn more with Gen AI tools.
Work Schedule: Monday–Friday, 8:00 AM–5:00 PM (EST).
- Provides outreach to members via phone to support with care plan next steps, community or health plan resources, questions or concerns related to scheduling, and ongoing education for both the member and provider throughout care/service
- Provides experienced support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service
- May apply in-depth knowledge of assigned health plan(s) activities and resources
- Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures and protocols
- Applies in-depth knowledge of care management support activities including care plans and community resources
- Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship
- Works with care management team on escalating requests and inquiries to management
- Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed
- May support training of new hires
- Performs other duties as assigned
- Comply with all policies and standards
Education/Experience: Requires a High School diploma or GED (minimum) and 2 - 4 years of related experience
Transferrable Skills:
- 4+ years of experience processing healthcare or insurance authorizations and coordinating services for members with access to Medicaid Long-Term Services and Supports (LTSS)
- Strong problem-solving skills, communication skills (i.e. be professional, customer-centric, inclusive, and tactful), and strong organizational and time management skills are required
- Ability to adapt to changing business needs with openness, flexibility, and professionalism
- Must be comfortable presenting findings clearly and concisely to various stakeholders
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
