Centene Corporation

Compensation

Full Description

Description: • Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes • Manage patient care plan and provide oversight for transplant processes and large dollar cases • Coordinate transplant requests from pre-approval to claims payment processes and assist with approved transplant center process within contractual timeframes • Ongoing communication with transplant facility, assigned case manager, medical director and finance to ensure materials are gathered for financial processing • Analyze and review transplant contract and claims and liaison with transplant contractor for approval and claim pricing • Maintain transplant and catastrophic case logs and perform related medical management and finance reporting • Ensure proper processing of high dollar transplant claims • Provide resource support to members and care managers for local resources (e.g., employment, housing, participant direction, independent living, justice, foster care) • Facilitate care management and collaborate with appropriate providers or specialists to ensure timely access to needed care or services • Perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources • Collects, documents, and maintains all member information and care management activities to ensure compliance with regulators • Provide and/or facilitate education to members and their families/caregivers on disease processes, resolving care gaps, care options, referrals, and healthcare benefits • Provide feedback to leadership on opportunities to improve and enhance care and quality delivery • Perform other duties as assigned by people leader to meet business needs Requirements: • Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing • 2 – 4 years of related experience • RN - Registered Nurse - AZ State Licensure and/or Compact State Licensure required • Candidates must live in AZ • Ability to collect, document, and maintain all member information and care management activities to ensure compliance with state, federal, and third-party payer regulators • Ability to perform telephonic, digital, home and/or other site outreach to assess member needs • Must comply with all policies and standards Benefits: • competitive pay • health insurance • 401K and stock purchase plans • stock purchase plans • tuition reimbursement • paid time off plus holidays • a flexible approach to work with remote, hybrid, field or office work schedules • Total compensation may also include additional forms of incentives • Benefits may be subject to program eligibility