Centene Corporation Program Specialist (Medical Management) in Austin, Texas
Position Purpose: Assist the Director Medical Management with auditing, training, data analysis, program and policy development for the medical management team for the entire Plan.
- Analyze turn around times of assigned tasks for medical management team, work loads, and reports
- Audit medical management cases to ensure compliance with designed programs and timeliness
- Develop and update policies and procedures to maintain alignment with current processes and articulate best practices in the industry
- Design programs to manage work loads and maintain performance standard and implement effective work functions
- Train medical management staff on new processes & procedures and systems
- Provide ongoing technical support to new and existing staff on systems, regulatory requirements, customer service, and other areas as needed
- Assist in prior authorization inventory
- Assist with provisions of Medicare Advantage Prescription Drug coverage and services
Education/Experience: Nursing degree in related field. 4 years of medical management or related experience.
License/Certification: LPN, LVN, or RN license.
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.
Job: Clinical & Nursing
Organization: Superior Health Plan
Requisition ID: 1040473