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American multinational healthcare company
Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management…
Position Purpose: Lead a team of professionals responsible for the strategic and operational execution of the strategic plan, typically including individual state initiatives as well as broad, national strategic…
This is a remote position that requires up to 75% travel. This role is eligible for a $2,500 sign-on bonus . This position supports foster care members in Reno, McPherson, Rice, Harvey, and neighboring counties.…
Position Purpose: Assist the Chief Medical Officer to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Key Details: This role requires a Board…
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including…
Position Purpose: Manage the compliance department functions, including but not limited to, periodic monitoring and auditing activities based on established compliance program, policies, and practices to ensure and…
Position Purpose: Lead and direct process improvement activities that provide more efficient and streamlined workflow. This leadership role will shape and execute the organization’s digital quality measurement…
This position is a field based role covering Lubbock and Amarillo Counties. Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client…
Position Purpose: Develop, implement and oversee the pharmacy benefit management program across multiple product lines in both centralized and regional environments with multiple locations. Ensure compliance with…
Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service…
Position Purpose: Oversee all compliance functions for the health plan including communication and coordination of policy development. Oversee the accurate and timely submission of over contract deliverables for all…
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care…
Position Purpose: The Senior Manager of Credentialing and PDM will oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance. Key Details: Must…
Position Purpose: Provide strategic and operational insights to senior leadership to drive the key initiatives and growth plans in the market. Collaborate with Corporate Strategy partners to ensure alignment with…
Position Purpose: Identify training needs to enhance performance, quality, and motivation of corporate and field staff for the Quality department. Develop, conduct, and evaluate the effectiveness of training programs.…
Position Purpose: Ensure regulatory compliance with Washington state and other government agencies related to the health insurance industry, Centene Corporation, and its business subsidiaries. Key Details: Candidates…
The Care Manager will be responsible for enrolling members in case management and completing required care management activities for individuals of all ages. The role requires strong communication, organization, and…
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