Jobs for Humanity is partnering with Centene 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

Join our team and make a difference in the lives of our 28 million members. We are looking for compassionate clinical professionals to join our Medical Management/Health Services team. At Centene, we value workplace flexibility and offer competitive benefits to our diverse national organization.

Oklahoma Complete Health, a Centene company, is dedicated to providing quality healthcare solutions that improve the health of Oklahomans.

At Oklahoma Complete Health, we believe in inclusivity and work-life balance. We offer competitive compensation and opportunities for continuous career development. Join us and become part of a collaborative network of innovative thinkers who are delivering local-level solutions.

Position Purpose: You will assist in various activities related to medical and psychosocial aspects of utilization and coordinated care.

• Initiate authorization requests for necessary services based on our prior authorization list. Conduct research for specific claims inquiries within your department's responsibility.
• Support member compliance by verifying appointments, obtaining lab results, and monitoring inpatient census.
• Screen for eligibility and benefits, and refer members without a primary care physician to our Member Services. Prioritize and assess members for case management. Perform transition-of-care duties, including contacting attending physicians, members or medical power of attorneys, and other medical providers for information on any special needs.
• Coordinate services with community-based organizations and represent our plan at marketing and outreach meetings as directed. Generate and send routine case management letters and educational materials.
• Enter assessments and authorizations into our system.

Education/Experience: You will need a high school diploma or equivalent. Ideally, you have 2-3 years of experience in a managed care setting, medical office, or facility, demonstrating proficient medical administration duties. It is important to have a comprehensive knowledge of customer service, utilization review, or claims processing practices in a managed care environment. Familiarity with medical terminology is also essential.

For Oklahoma Medicaid and Children’s Specialty contract: A bachelor's degree in nursing, psychology, social work, or a related field is required, along with at least one year of related professional experience in serving individuals in Medicaid and/or Foster Care in the human services field.

We offer a comprehensive benefits package, including:

• 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 opportunities

Centene is an equal opportunity employer committed to diversity. We value and celebrate our differences. 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.