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Utilize a variety of quantitative and qualitative analysismethods to evaluate results from member satisfaction surveys to assess healthplan operations and identify, prioritize, and lead process improvementactivities to enhance the member experience as measured by the CAHPS score andHOS scores. Provide functional and technical knowledge for NCQA/HEDIS across all plan departmental staff and deliver
Posted 5 days ago
Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Maintain integrity of PHI. Maintain working relationships with other departments. Research claims inquiry specific to the department and responsibility. Attend ongoing t
Posted 30 days ago
Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with
Posted 1 month ago
Centene Corporation
- Erie, PA / Franklin, PA / Washington, PA / 3 more...
Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company's policies and programs. Provide greater access to health insurance, by providing education and assistance to Medicare individuals. Distribute health education materials and arrange for health screenings. Provide Facilitat
Posted 2 months ago
Centene Corporation
- Austin, TX / Raleigh, NC / San Antonio, TX / 5 more...
Oversee activities of the provider contracting, network development and/or provider relations functions and aid in formulating and administering organizational policies and procedures. Oversee provider contracting activities to ensure efficiency and maintain compliance with the business unit's policies and standards, government laws and regulations Implement development activities for the recruitm
Posted 2 months ago
Centene Corporation
- Austin, TX / Raleigh, NC / San Antonio, TX / 5 more...
Recruit physician, hospital and ancillary service providers to sign network participation agreements that are in accordance with Corporate, health plan and State guidelines. Ensure that all necessary documentation and information are included. Recruit and develop network for a region and set of providers Lead assigned recruitments (i.e., physician, hospital and ancillary) and ensure they result in
Posted 2 months ago
Centene Corporation
- Harrisburg, PA / Pittsburgh, PA
Compile and analyze financial information for the company. Lead various financial projects. Cost effectively manage the utilization of services and develop measures to track, trend and forecast related impacts of organizational strategic initiatives. Run pre established reports as well as development of new reports for internal stakeholders and regulatory agencies Develop metrics to evaluate finan
Posted 3 months ago
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