Program Coordinator Ii Jobs

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.

• Data enter assessments and authorizations into the system and maintain database as directed
• Initiate authorization requests for output or input services in keeping with the prior authorization list
• Identify members without a PCP and refer to Member Services and answers phone queues and faxes within established standards
• Coordinates services with community based organizations, and attend marketing and outreach meetings as directed to represent the plan
• Assess and monitor inpatient census and screen for eligibility and benefits
• Maintain integrity of PHI and working relationships with other departments
• Produces and mails routine CM letters and program educational materials, and assist develop marketing and outreach meetings as directed to represent the health plan
• Research claims inquiry specific to the department and responsibility
• Attend ongoing training and inservices as directed, and perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results
• Train new Program Coordinators on system and usage and guide staff regarding benefits, authorization requirements and policy and procedures

Education/Experience: High school diploma or equivalent; 3-5 years managed care setting, medical office or facility setting with demonstration of medical administration duties. Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology. Licenses/Certifications: LPN license highly preferred. For Illinois Youth Care contract: Required Education/Experience – Bachelor’s Degree in nursing, social sciences, social work, or a related field. 1 year supervised clinical experience in a human services field. For Oregon plan only: A valid driver's license is required.

Our Comprehensive Benefits Package: 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. 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.