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

Are you passionate about making a difference in the lives of 28 million people? We have an opportunity for you to join our Medical Management/Health Services team and be the catalyst for change. At Centene, a national organization, we offer competitive benefits and a fresh take on workplace flexibility.

Position Purpose:

Join us in supporting our members by assisting in the medical and psychosocial aspects of utilization and coordinated care.

• Initiate authorization requests for necessary services based on our prior authorization list. Research claims inquiries specific to your department and responsibility.
• Execute tasks to promote member compliance, such as verifying appointments and obtaining lab results. Additionally, assess and monitor inpatient census.
• Screen for eligibility and benefits, helping identify members without a Primary Care Physician (PCP) and referring them to Member Services. Prioritize members for case management assessment. And in regards to transition of care, contact the member's attending physician, member, medical power of attorney, and other medical providers (home health agencies, equipment vendors) to gather information about special needs.
• Coordinate services with community-based organizations and represent the plan in marketing and outreach meetings when required. You will also produce and mail routine case management (CM) letters and educational materials.
• Enter assessments and authorizations into the system accurately.

Education/Experience:

We value dedication and experience. You should have a high school diploma or equivalent, along with 2-3 years of experience in managed care setting, medical office, or facility setting demonstrating medical administration duties. A thorough knowledge of customer service, utilization review, claims processing practices in a managed care environment, and proficiency in operating office equipment such as personal computers is essential. Understanding medical terminology is also important.

Additional Requirements:

If you are applying for the Illinois Youth Care contract, you must have a Bachelor's Degree in nursing, social sciences, social work, or a related field, along with one year of supervised clinical experience in a human services field. Candidates are also required to reside within the specified region.

For the Oregon plan, a valid driver's license is mandatory.

If you are applying for the Oklahoma Medicaid and Children's Specialty contract, a Bachelor's Degree in nursing, psychology, social work, or a related field, as well as at least one year of professional experience in the human services field serving individuals in Medicaid and/or Foster Care is required.

Our Comprehensive Benefits Package:

• Flexible work options including remote possibilities and hybrid work schedules with 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 top-notch training and development opportunities

Centene is an equal opportunity employer dedicated to embracing diversity and cherishing our differences. We recognize and value the unique contributions each individual brings to our team. 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 any other characteristic protected by applicable law.

If you believe you are the right fit for this role, please submit your application below.