Business Analyst I
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time.
As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose : Perform various analysis and interpretation to link business needs and objectives for assigned function
- Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
- Identify and analyze user requirements, procedures, and problems to improve existing processes
- Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementationEducation / Experience : Bachelor’s degree in related field or equivalent experience.
0-2 years of business process analysis or data analysis experience. Advanced knowledge of Microsoft Applications, including Excel and Access preferred.
Project management experience preferred. Benefits and Payment ConfigurationCompliance Coding / Prepay Compliance (Payment Integrity)Bachelor’s degree in related field or equivalent experience.
0-2 years of business process analysis (i.e. documenting business process, gathering requirements) or claims payment / analysis experience.
Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Provider DataBachelor’s degree in related field or equivalent experience.
0-2 years of business process analysis (documenting business process, gathering requirements) experience in healthcare industry and / or working in a data driven environment.
Advanced knowledge of Microsoft Applications, including Excel, Project, and Visio preferred. Knowledge of data migration, software enhancement / planning, and Agile preferred.
Member & Provider SolutionsBachelor’s degree in related field or equivalent experience. 0-2 years of business process analysis (i.
e. documenting business process, gathering requirements) experience in healthcare industry and / or customer service or enrollment functions.
Advanced knowledge of Microsoft Applications, including Excel and Visio preferred. Knowledge of data integration, software enhancements / planning and Agile preferred.
Experience managing projects with a high reliance on technology preferred.
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.
Care Manager, RN
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 care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
This is a remote / field based position with travel required. Candidate should reside in or near Laredo, TX, and must be willing to travel to the surrounding areas up to 4 days per week.
RN licensure required.Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
Provide patient and provider education
Facilitate member access to community based services
Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources.
Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
Direct care to participating network providers
Perform duties independently, demonstrating advanced understanding of complex care management principles.
Participate in case management committees and work on special projects related to case management as needed
Education / Experience : Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting.
Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.
e. Interqual, NCCN) and government sponsored managed care programs.
Licenses / Certifications : Current state’s RN license.
Texas Requirements :
Education / Experience : Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting.
2+ years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment.
Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs. Other state specific requirements may apply.
Licenses / Certifications : Current state’s RN license.
Additional Details :
Remote / Field position
Laredo, TX and surrounding areas
Travel required up to 4 days per week
RN licensure required
Home health or nursing facility experience preferred
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.
Case Manager, Clinical
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.
Hiring Case Managers - full-time LPC or LCSW positions available in Beaumont, TX, Groves, TX Lumberton, TX, Port Arthur, TX, Nederland, TX, Port Neches, TX, Rose Hill Acres, TX, Silsbee, TX or Orange, TX.
Monday - Friday : 8 am - 5 pm (CST)
Competitive Salary, Sign On Bonus, Full-time Benefits, 401(k), PTO, Holiday Pay, Mileage Reimbursement and more!
Work from home AND travel to conduct behavioral health assessments IN-PERSON with child / adolescents' members.
Perform duties related to the day-to-day operations of the Service Management functions for Foster Care members to achieve the highest possible levels of functioning and wellness by ensuring consistent, timely access to medically necessary behavioral health services.
Monitor quality of care, assist with discharge planning.
Work with Foster Care Members, Medical Consenters, Department of Family and Protective Services (DFPS) staff and providers to meet the behavioral healthcare needs of each foster care member’s condition.
- Work with Foster Care Members, Medical Consenters, Department of Family and Protective Services (DFPS) staff and providers to meet the behavioral healthcare needs of each foster care member’s condition.
- Conduct behavioral health assessments IN-PERSON and identify foster care members who may benefit from service management, conduct an assessment and develop, implement and monitor a healthcare service plan.
- Provide information to DFPS staff to facilitate development of the DFPS case plan.
- Update database regularly with most recent Service Management Plan of Care.
- Review information submitted by providers into the database to ensure material is appropriate and consistent with guidelines for data inclusion.
- Encourage behavioral health providers to use evidence-based practices and confirm that behavioral health providers and PCP’s are sharing information as required.
- Comply with established referral, pre-certification and authorization policies, procedures and processes by related medical management staff.
- Maintain compliance with federal and state regulations and contractual agreements.
- Coordinate service management functions with other departmental functions.
- Monitor data to address trends or potential quality improvement opportunities and maintain HIPPA compliance.
- Travel is required, and mileage reimbursement is provided
Education / Experience :
Master's degree in relevant field (e.g. social work, counseling, psychology) specializing in psychiatric / mental health.
3+ years of direct behavioral health / psychiatric experience, case management, utilization management, or service coordination
Preferred Qualifications :
Must be able to work independently with minimal supervision.
3+ years' experience working with children and adolescents with special needs or behavioral / mental health conditions within CPS, DFPS, child welfare systems, or local and state mental health authorities.
Experience working in behavioral health Field-Based roles within social services, patient advocacy, and / or experience with community and mental health resources for child / adolescent members and Medicaid recipients.
Experience administering psychological assessments and managing high volume caseloads is preferred.
Role requires strong organization and customer services skills
Proficient computer skills and experience working within large databases or provider information systems and Microsoft Office applications.
License / Certification : Fully licensed as a LCSW or LPC (for the applicable state) and an active driver’s license is required.
NOTE : Department of Family and Protective Services (DFPS) background is required.
Hiring Case Managers - full-time LPC or LCSW positions available in Beaumont, TX, Groves, TX Lumberton, TX, Port Arthur, TX, Nederland, TX, Port Neches, TX, Rose Hill Acres, TX, Silsbee, TX or Orange, TX.
Monday - Friday : 8 am - 5 pm (CST)
Competitive Salary, Sign On Bonus, Full-time Benefits, 401(k), PTO, Holiday Pay, Mileage Reimbursement for travel and more!
LPC - Associate, License Master Social Worker (LMSW), and RN is NOT eligible for this position.
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.
Finance Analyst III (Excel, Financial Modeling)
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time.
As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Remote Available
Position Purpose : Compile and analyze financial information for the company. Lead various financial projects.Develop integrated revenue / expense analyses, projections, reports, and presentations
Create and analyze monthly, quarterly, and annual reports and ensures financial information has been recorded accurately
Identify trends and developments in competitive environments and presents findings to senior management
Perform financial forecasting and reconciliation of internal accounts
Handle complex and high level financial analysis
Present and discuss analysis with upper management
Experience with financial modeling.
Analytical skills and problem-solving abilities, with strong attention to detail.
Self-starter with excellent interpersonal communication skills.
Advance skills in Microsoft Excel, including PivotTables, V-lookups, PowerPivot, etc.
Preferred : Experience with vendor ROI analyses and business process improvement.
Understanding of SQL code or Enterprise Data Warehouse experience is a plus.
Education / Experience : Bachelor's degree in related field or equivalent experience. 4+ years of financial or data analysis experience.
Advanced skills in Microsoft Excel.
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.