Jobs for Humanity is partnering with Centene Corporation to build an inclusive and just employment ecosystem. Therefore, we prioritize individuals coming from the following communities: Refugee, Neurodivergent, Single Parent, Blind or Low Vision, Deaf or Hard of Hearing, Black, Hispanic, Asian, Military Veterans, the Elderly, the LGBTQ, and Justice Impacted individuals. This position is open to candidates who reside in and have the legal right to work in the country where the job is located.

Company Name: Centene Corporation

Job Opportunity: Clinical Professional on our Medical Management/Health Services Team

We are looking for compassionate individuals to join our Medical Management/Health Services team at Oklahoma Complete Health, a Centene company. As a clinical professional, you have the opportunity to make a difference in the lives of our 28 million members by ensuring their timely and safe transition into or out of our health plan.

At Oklahoma Complete Health, we are committed to providing quality healthcare solutions that transform the health of Oklahomans. We value an inclusive culture and prioritize work-life balance, competitive compensation, and continuous career development for our employees.

Position Purpose:

• Manage the transition of care for members joining or leaving our health plan
• Identify new enrollees who require transition of care services
• Assess the healthcare needs of new enrollees
• Determine if there are any active care needs or outstanding service authorizations
• Contact previous Managed Care Organizations (MCOs) and/or Primary Care Providers (PCPs) to obtain relevant enrollee information, if applicable
• Ensure that existing authorizations with previous health plans or fee-for-service are honored during the transition for at least 60 calendar days from enrollment
• Assist enrollees with 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 enrollees
• Educate transitioning enrollees about services, requirements, and limitations/exclusions resulting from the transition

Requirements:

• Reside in the state of Oklahoma
• 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
• Valid driver's license (Social Worker, LPN, LVN, or RN preferred)

Benefits:

• 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. We welcome applicants from all backgrounds and walks of life. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by applicable law.

How to Apply:

If you are interested in this position, please fill out the form below and submit your application. We look forward to reviewing your application and considering you for this opportunity.

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Please note that only qualified applicants will be contacted for further consideration. Thank you for your interest in joining our team!