Jobs for Humanity is partnering with Oklahoma Complete Health 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: Oklahoma Complete Health

Job Advertisement: Join Us in Changing Lives

At Centene, we are looking for compassionate individuals from all backgrounds to join our Medical Management/Health Services team and make a difference in the lives of our 28 million members. We offer competitive benefits and a fresh perspective on workplace flexibility.

Position Purpose: Help Members Transition to Better Health

• Manage the transition of care for members joining or leaving our health plan.
• Identify new enrollees in need of transition of care services.
• Assess the healthcare needs of new enrollees.
• Determine if there are any outstanding service authorizations or ongoing care needs.
• Contact previous healthcare providers to obtain relevant information, if applicable.
• Ensure that existing authorizations and services are continued for at least 60 days after enrollment.
• Assist members with ongoing care authorizations, transitions to different healthcare programs, and transitions to private insurance or no coverage.
• Coordinate care plans with community care coordinators and the member.
• Educate transitioning members about available services, requirements, and limitations.

Education/Experience:

• Bachelor's degree in Social Work, Nursing, Health, Behavioral Science, or equivalent experience.
• 3+ years of related experience.
• Knowledge and experience working with Medicaid recipients with 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.

For LA Healthcare Connections:

• Valid driver's license preferred.

For PA Health & Wellness plan:

• RN or LPN license required.

For North Carolina only:

• Assist members in transitioning between different clinical settings to prevent readmissions or adverse outcomes.
• Must reside in NC.

Our Comprehensive Benefits Package Includes:

• 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 unique contributions of each individual. 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.

Dear [Hiring Manager], I am writing to express my interest in the clinical professional position on your Medical Management/Health Services team. I believe that I can make a meaningful impact on the lives of the 28 million members at Centene. As a clinical professional, I will be responsible for ensuring a safe and timely transition of members into or out of the health plan. My role will involve managing the transition of care for members, identifying their healthcare needs, coordinating care plans with community care coordinators, and educating them about available services and requirements. I have a Bachelor's degree in [relevant field] and over [number] years of experience in supporting individuals with disabilities and behavioral health conditions. My experience in insurance and utilization review will enable me to navigate the complexities of healthcare transitions effectively. I hold a valid driver's license, and I am a [certification/license], which equips me with the necessary skills to excel in this role. For [specific plans/locations], I meet the specific requirements outlined in the job description. I am particularly excited about Centene's comprehensive benefits package, which includes flexible work solutions, competitive pay, paid time off, health insurance coverage, 401(k) and stock purchase plans, and opportunities for professional development. Furthermore, I appreciate Centene's commitment to diversity and inclusion. As an individual from [underrepresented group], I believe in the power of embracing and valuing our differences to create a more inclusive and equitable society. I have attached my resume for your review. Thank you for considering my application. I look forward to the opportunity to contribute to Centene's mission of improving the lives of millions of individuals. Sincerely, [Your Name]