Centene jobs - 1,527 jobs

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: Establishes and fosters a healthy working relationship between community physician and small provider practices and WellCare. Educates providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS. Under general guidance form Senior Quality Practice Advisors and management, educates community physician and small provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements. Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement. Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Assists in delivering provider specific metrics and coaches providers on gap closing opportunities. Assists in identifying specific practice needs where WellCare can provide support. Partners with physicians/physician staff to find ways to encourage member clinical participation in wellness and education. Provides resources and educational opportunities to provider and staff. Captures concerns and issues in action plans as agreed upon with provider. Documents action plans and details of visits and outcomes. Reports critical incidents and information regarding quality of care issues. Communicates with external data sources as needed to gather data necessary to measure identified outcomes. Provides communication such as newsletter articles, member education, outreach interventions and provider education. Supports quality improvement HEDIS and program studies as needed, requesting records from providers, maintaining databases, and researching to identify members' provider encounter history. Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements. Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline. Enter documentation of findings in identified databases and ensure accuracy in medical records for data collection, DE and reporting. Performs other duties as assigned. Performs other duties as assigned Complies with all policies and standards The ideal candidate will be based in Kalamazoo, Calhoun, Barry, Ionia, Kent, Ottawa, or Muskegon counties in Michigan, and possess strong quality experience. This role requires up to 50% travel in those counties. Education/Experience: Required A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field or equivalent work experience within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets that demonstrates the ability to perform the role. Preferred: A Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field. Candidate Experience: Required: 1+ year of experience in related HEDIS medical record review or quality improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff OR 2 years medical coding or other transferable experience and skill set combination that demonstrates the ability to learn and perform the level of the position. A license in one of the following is preferred: Certified Coding Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Licensed Vocational Nurse (LVN), Licensed Mental Health Counselor (LMHC), Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse (RN), Acute Care Nurse Practitioner (APRN) (ACNP-BC), Other Foreign trained physician/MD, Health Care Quality and Management (HCQM), Certified Healthcare Professional (CHP), Certified Professional in Healthcare Quality (CPHQ). Pay Range: $27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

The Telephonic Case Manager RN in Medical Oncology provides remote nursing support by coordinating patient care, educating members, and ensuring adherence to treatment plans. This role involves assessing patient health, identifying barriers, and connecting patients with necessary resources to improve health outcomes. Working primarily via telephone, the position requires strong clinical expertise, communication skills, and proficiency in healthcare technology systems. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today! The Telephonic Case Manager RN Medical/Oncology will identify, coordinate, and provide appropriate levels of care. The Telephonic Case Manager RN Medical/Oncology is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. This is a full-time, Monday - Friday, 8am-5pm position in your time zone. You'll enjoy the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Make outbound calls and receive inbound calls to assess members current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self-management Make referrals to outside sources Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. Solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN license in state of residence Active Compact RN License or ability to obtain upon hire 3+ years of experience in a hospital, acute care or direct care setting Proven ability to type and have the ability to navigate a Windows based environment Have access to high-speed internet (DSL or Cable) Dedicated work area established that is separated from other living areas and provides information privacy Preferred Qualifications BSN Certified Case Manager (CCM) 1+ years of experience within Medical/Oncology Case management experience Experience or exposure to discharge planning Experience in a telephonic role Background in managed care *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: telephonic case management, oncology nurse, patient education, care coordination, medical management, healthcare advocacy, remote nursing, chronic disease management, UnitedHealth Group, RN license

A leading health services company is hiring a Lead Experience Researcher to drive high-impact experiences by blending qualitative and quantitative research expertise. This position is crucial in uncovering unmet needs and informing strategic solutions while partnering with cross-functional teams. An ideal candidate will possess a Bachelor's degree, a minimum of five years in experience research methods, and a passion for human-centered innovation. This remote role offers a competitive salary range of $138,900 - $191,000, along with comprehensive benefits. #J-18808-Ljbffr

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Community Health Worker is responsible for assessment, planning and implementing care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care. They also Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services, and manage the care plan throughout the continuum of care as a single point of contact for the member. As a Community Health Worker (CHW), you will act in a liaison role with Medicaid members to ensure appropriate care is accessed as well as to provide home and social assessments and member education. The coordinator also addresses social determinant of health such as transportation, housing, and food access. Working Schedule: Monday through Friday between the hours of 8 am to 5pm. No nights, weekends, or holidays. Local travel up to 50% and mileage is reimbursed at current government rate. This position is a field-based position with a home-based office. You will work from home when not in the field. If you reside within Hamilton County, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Engage members either face to face or telephonically to assist with closing gaps in care, linking to necessary services and providing education about their health Review available member services records and relevant documentation (e.g. utilization history, functional level, stratification information) Conduct member health assessments that include bio-psychosocial, functional, and behavioral health needs Utilize interviewing techniques and active listening to collect and retain member information and incorporating responses as they are presented to complete assessment Identify member service needs related to health concerns Identify urgent member situations and escalate to next level when necessary Engage member to participate in the assessment process and collaboratively develop Health Action Plan based on their individual needs, preferences, and objective with nursing oversight Work with members to develop healthcare goals and identify potential barriers to achieving healthcare goals Identify member support systems available and incorporate into their Health Action Plan Review plan benefits and identify appropriate programs and services based on health needs and benefits Integrate health care and service needs into a plan or recommendation for member care and service Work collaboratively with the interdisciplinary care team to ensure an integrated team approach Collaborate with member to create solutions to overcome barriers to achieving healthcare goals Identify relevant community resources available based on member needs Refer members to appropriate programs and services Facilitate member choice of preferred providers Advocate for individuals and communities within the health and social service systems You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: High School Diploma/GED (or higher) 1+ years of experience with knowledge of the resources available, culture, and values in the community Intermediate level of computer proficiency (including Microsoft Outlook, Teams) and ability to use multiple web applications Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) Must reside within a commutable distance to Cincinnati, Ohio area and the surrounding communities Valid driver's license and current automobile insurance with access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area Ability to travel locally, up to 100 miles round trip and up to 50% of the time Must reside within Hamilton County, Ohio Preferred Qualifications: Associate degree (or higher) in a health-related field LPN (Licensed Practical Nurse) Licensure or CNA / HHA Community Health Worker (CHW) Accreditation 1+ years of field-based experience Experience/position with Community outreach Experience/position in healthcare Experience working in Managed Care Experience/position in a Community Health Related field Knowledge of Medicaid/Medicare population *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RED

A national healthcare organization is seeking a Risk Management Lead to oversee risk adjustment operations and compliance. This role requires a minimum of three years of project leadership experience and expertise in audit and compliance. The ideal candidate will have strong relationship-building skills and the ability to manage multiple projects effectively. This remote position offers a salary range of $104,000 to $143,000 annually, along with competitive benefits including health insurance and a 401(k) plan. #J-18808-Ljbffr

A healthcare services provider is seeking an Actuary for Analytics/Forecasting to join their Financial Planning team. This role involves analyzing financial data, collaborating with stakeholders, and providing strategic insights to support business decisions. Candidates should possess a Bachelor's degree, FSA or ASA certification, and strong communication skills. The position offers remote work flexibility with occasional office travel required. A competitive compensation package and benefits are provided. #J-18808-Ljbffr

A leading healthcare company is seeking a Director - Automations & Efficiencies to lead innovative projects aimed at enhancing operational effectiveness. This role involves overseeing automation initiatives in a healthcare environment, managing strategic partnerships, and improving processes through advanced technologies. The ideal candidate has significant experience in healthcare payer operations, RPA technologies, and cross-functional leadership. This position offers flexibility to work remotely from anywhere within the U.S. #J-18808-Ljbffr

OneGI is seeking a BC/ BE Gastroenterologist to join an established practice in Dayton, Ohio. This is a fantastic opportunity to practice high quality clinical care in a large, collegial practice. Highlights: General GI Practice; EUS in OP facilities 1:7 generous call schedule APP support Infusion, Pathology, Fibroscan, Research, Hem Banding, CCM, Anesthesia support services Strong relationship with community Level 1 Trauma Center 3 ASC locations with ownership potential 2-year practice partnership track Benefits: Competitive Base Salary with Competitive Production Earnings Sign On Bonus and Moving Expenses Medical, Dental, Vision, 401k Match Malpractice Insurance At One GI , we provide exceptional gastroenterology care that puts patients at the forefront. Since our inception in 2020, we have grown rapidly while remaining steadfast in our commitment to driving excellence and upholding the highest standards in gastroenterology practice. Our renowned physician leadership, collaborative team culture, state-of-the-art ancillary services, and robust network strength empower our physicians to deliver personalized, compassionate care tailored to each patient's unique needs. One GI is more than just an organization; it's a community of over 1,300 dedicated individuals united by a shared purpose: creating a better healthcare experience for patients, colleagues, and communities. We are a diverse team of professionals who bring our unique perspectives and expertise to the table, fostering an environment of collaboration and continuous improvement. Each One GI practice is the leading provider of gastroenterology care in its respective community, retaining its regional name and unique reputation while leveraging the expansive resources and backing of our national organization. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status.

OneGI is seeking a BC/ BE Gastroenterologist in Brunswick, Ohio. A terrific opportunity to join an outpatient practice that provides world-class care! Highlights: General GI Practice; 100% outpatient/ASC setting APP support Infusion, Pathology, Research, Anesthesia, Hem Banding available support services 1 ASC location with ownership potential 2-year practice partnership track Benefits: Competitive Base Salary with Competitive Production Earnings Sign On Bonus and Moving Expenses Medical, Dental, Vision, 401k Match Malpractice Insurance At One GI , we provide exceptional gastroenterology care that puts patients at the forefront. Since our inception in 2020, we have grown rapidly while remaining steadfast in our commitment to driving excellence and upholding the highest standards in gastroenterology practice. Our renowned physician leadership, collaborative team culture, state-of-the-art ancillary services, and robust network strength empower our physicians to deliver personalized, compassionate care tailored to each patient's unique needs. One GI is more than just an organization; it's a community of over 1,300 dedicated individuals united by a shared purpose: creating a better healthcare experience for patients, colleagues, and communities. We are a diverse team of professionals who bring our unique perspectives and expertise to the table, fostering an environment of collaboration and continuous improvement. Each One GI practice is the leading provider of gastroenterology care in its respective community, retaining its regional name and unique reputation while leveraging the expansive resources and backing of our national organization. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status.

Join Medical Mutual, Ohio's oldest and one of the largest health insurers, and help us deliver peace of mind to over 1.2 million members! Our mission is to help people live healthier lives by providing high-quality, affordable health coverage and supporting the communities we serve. As VP, Assistant General Counsel, you will be a strategic partner to executive leadership, guiding decisions that protect our reputation and advance our mission. Position is headquartered in Brooklyn, OH 4 days/week onsite. Make An Impact Advise senior leaders and business units on complex legal, regulatory, and transactional matters Lead the legal team in managing risk and supporting business growth Represent Medical Mutual in high-stakes negotiations and litigation Influence corporate strategy and policy development Ensure our organization adapts to changing laws and regulations What We're Looking For J.D. from an accredited law school Licensed (or eligible) to practice law in Ohio or able to transition to practice law in Ohio 10+ years of progressive legal experience, preferably with 5 years of health insurance experience 8+ years in management Strong analytical and problem-solving skills. Proven ability to research and apply legal principles Why Medical Mutual? Competitive salary, bonus, and 401(k) with company match up to 4% and an additional company contribution Excellent medical, dental, vision, life, and disability insurance Generous PTO, holidays, and parental leave Career development, mentoring, and tuition reimbursement Wellness programs, gym access, and business casual dress Inclusive and supportive culture Apply now and help us shape the future of healthcare in Ohio-your leadership will directly impact our members and communities. About Medical Mutual Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us. There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans. At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status. We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Requisition ID JR1004586 Category Claims - Subrogation Type Regular Full-Time Amtrust Financial Services, a fast-growing commercial insurance company, is seeking a Subrogation Claims Investigator. The successful candidate will directly handle subrogation related claims. The This adjuster role is responsible for prompt and independent investigations and review of subrogation claims through effective coverage analysis and liability investigation. In this role, the adjuster is responsible for negotiations and interactions with insureds, claimants, adverse parties, and counsel. The successful candidate will evaluate risk transfer opportunities as well as ensuring appropriate investigation of the underlying facts and circumstances is carried out, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, and proper negotiation strategy is employed. This position reports to a line of business supervisor or manager. This position may require hybrid attendance in an AmTrust location. The expected salary range for this role is $46,600 - $60,000. Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. Responsibilities * Investigates the claim or coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured or employer. representatives, claimant or injured party, witnesses, producers, and adverse parties. * Documents strategy, action plan, and summary of correspondence in a clear, succinct, and fact-based manner. * Notifies all potential parties, legal representatives, and insurance companies of our subrogation interest. * Ensures quality and timely service is provided to all internal and external customers, whether directly or indirectly. * While working with internal or assigned Legal Counsel, will build strong relationships, and apply company principles and standards. * Effectively negotiates and resolves litigated and non-litigated subrogation claims, and leverages relationships to achieve optimal outcomes. * Manages and controls loss adjustment expenses while pursuing the best potential recovery outcomes. * Builds and leverages critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret, and understand key or root issues. * Effectively prioritizes work while driving claims resolution for the best potential outcome. * Escalates claims decisions regarding settlement determination when appropriate to management. * Performs other functional duties as assigned. Qualifications Minimum Qualifications *Bachelor's degree or equivalent experience. * State licensure as required. * Demonstrated proficiency with MS Office suites. * Demonstrated skills in loss investigations, evaluations, and negotiations. * Knowledge of insurance liability, theory, and practices. Preferred: * Multi-jurisdictional exposure preferred. * Ability to obtain licensure as required. * Some ability to travel may be required. Unique Minimum Qualifications: * Sound technical experience with negotiations and investigations. * Candidate should have knowledge of commercial general liability, commercial automobile, property and/or Workers' Compensation insurance coverages. * Ability to review and interpret contracts, legal documents, and medical records. * Knowledge of jurisdictional statutes and case law. * Ability to communicate effectively and clearly with many different parties both verbally and written. * Knowledge of claim procedures, policies, state and federal laws and insurance regulations. * Experience with litigation, mediation, and arbitration What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future. Connect With Us! Not ready to apply? Connect with us for general consideration.

A leading healthcare company is seeking an experienced Infrastructure Operations leader to drive innovation in AI and cloud technologies. The ideal candidate will have over 10 years in infrastructure, with a strong background in AI/ML, leading cloud operations for Azure and AWS. Key responsibilities include overseeing cloud strategy and governance, enhancing operational performance, and fostering partnerships across teams. This role offers a competitive salary and benefits focused on well-being. #J-18808-Ljbffr

A leading healthcare services company in Washington seeks a Workforce Management Professional 2 to analyze workforce needs and develop operational insights. The role requires 2+ years of scheduling experience, and proficiency in Microsoft Office. This remote position entails occasional travel for training. Competitive salary ranging from $59,300 to $80,900 per year, plus benefits focused on whole-person well-being. #J-18808-Ljbffr

A leading healthcare organization is seeking an Associate Director, Finance Data Management based in Honolulu, Hawaii. This role involves supporting all aspects of finance data management and implementing vital policies. Candidates must have a Bachelor's degree and extensive experience in ERP systems and finance functions. Additionally, proficiency in managing large datasets and SQL is required. Join a dynamic team to help enhance data architecture and improve operational efficiencies. #J-18808-Ljbffr

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. ***NOTE: For this role we are seeking candidates who live within the Eastern Standard Time Zone*** Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices. Serve as primary contact for providers serving as a liaison between the provider and the health plan Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on site and routing to the appropriate party for resolution Receive and respond to external provider related issues Initiate entry or change of provider related database information and oversee testing and completion of change request Investigate, resolve and communicate provider claim issues and changes Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem solving Perform provider orientations, including writing and updating orientation materials Ability to travel Performs other duties as assigned Complies with all policies and standards Education/Experience: High school diploma or equivalent. Bachelor's degree in healthcare related field preferred. 3+ years of sales, provider relations, or contracting experience. Knowledge of health care, managed care, Medicare or Medicaid. Claims billing/coding knowledge preferred. Driver's License may be required by some plans. Specific language skills may be required by some plans. License/Certification: Valid driver's license.Pay Range: $23.23 - $39.61 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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 REQUIRES 50% TRAVEL TO PROVIDERS OFFICES******CANDIDATE MUST RESIDE IN STATE OF INDIANA*** Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers. Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements. Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure. Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Identifies specific practice needs where Centene can provide support. Develops, enhances and maintains provider clinical relationship across product lines. Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards. Ability to travel up to 50% of time to provider offices. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree or equivalent required. 3+ years in HEDIS record collection and risk adjustment (coding) required Licenses/Certifications: One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS For Managed Health Services - IN - No license/certification is required Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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. ***NOTE: For this role we are seeking candidates who live in Honolulu, Hawaii*** Position Purpose: Manage the daily operations of all provider data management functions. Direct provider data management related activities based on plan and contract specifications and standard business rules - includes data analysis and entry, review of data via internet sites and other systems, usage of multiple systems and applications to validate data is complete and accurate, and investigation and resolution of data issues. Manage the end-to-end provider data entry and maintenance to ensure accurate and timely setup for claims payment, member assignment and directory display Investigate and resolve complex provider data management issues Identify trends and recommend improvements to mitigate potential issues Lead task assignment for team's workflow and distribution Monitor team performance to ensure established and provider data quality benchmarks are met Facilitate meetings with Health Plan representatives Train and mentor Provider Data Management Analyst I, II, and Team Leads Performs other duties as assigned Complies with all policies and standards Education/Experience: Bachelor's degree in related field or equivalent experience. 3+ years of combined management and provider data management, data analysis, and customer service experience preferably with healthcare operations (i.e. claims processing, billing, provider relations or contracting) experience in a managed care, insurance, or medical office environment. Experience performing and leading teams.Pay Range: $56,200.00 - $101,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

*$2,000 sign on bonus for external candidates plus an additional $1,000 if candidates have their licensure at time of offer. Guaranteed base pay + monthly sales incentive earning potential. Training fully onsite with a hybrid schedule after the completion of training!* At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. We are growing our team in Columbus, Ohio and have multiple Early Careers full-time sales opportunities available - come join our team as a Sales Agent in the Sales Development Program. In this inbound call role, you will receive a competitive base salary and bonuses based on your sales performance. You will consult customers on their insurance needs and match the correct coverages, products and benefits. Our training classes not only prepare you for your role, but we will pay for and provide support for you to obtain the required state insurance licenses. No license is required prior to starting in the role. During training, all new hires will be required to successfully complete the UHC Portfolio Agent New Hire training classes and demonstrate proficiency of the material. Work Schedule: Operating hours: Monday - Friday 7:00AM - 9:00PM; your shift will be provided during training with rotational weekend work Full time position with flexibility desired based on the seasonality of our business Work Location: Fast forward your success by participating in our onsite training program in a standard day shift for 6 - 10 weeks Site location: 5900 Parkwood Place, Dublin, OH 43016 Training fully onsite with a hybrid schedule after the completion of training Program features: Participate in a Sales Development Program that will accelerate your career with a company that will help you learn new skills and foster your continued growth Collaborate with experienced professionals, mentors, and sales leaders Build relationships within a close-knit community of peers involved in the development program to expand your network Development program is curriculum based and structured Program commitment is 18 months So, what's in it for you? Compensation & Benefits: As a licensed agent, your total compensation is determined by your ability to work hard, sell, and deliver a great customer experience Compensation = Base pay + monthly sales incentive Average first year annual earnings $60K through a combination of base plus sales commissions Top performers can earn $80K+ Sign-on bonus of up to $3,000 for external candidates (2k sign on bonus + an additional 1k if you have resident license at the time of offer) 18 days accrued Paid Time Off during first year of employment plus 8 Paid Holidays Medical Plan options along with participation in a Health Spending Account or a Health Saving account Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement Employee Discounts Employee Assistance Program Employee Referral Bonus Program Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) Fun and competitive work environment focused both on teamwork and individual success! Primary Responsibilities: Mainly handling inbound calling, NO knocking on doors Answer incoming phone calls from prospective members and identify the type of assistance and information the customer needs with the goal to convert the caller to a qualified lead and ultimately sale Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems Using knowledge of the product portfolio to accurately assess the distinct needs of different prospects, explain the differences between various products, and assist the prospect member in selecting a product that best meets their unique needs May make outbound calls to members to follow up on questions or to current members to review current or new products and services Assist the prospect in completion of the enrollment application over the phone with complete, accurate and required information, consistent with product requirements and enrollment guidelines Meet the goals established for the position in the areas of performance, attendance, and consumer experience Meet and maintain requirements for agent licensure, appointments, and annual product certification You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. *This is a full-time position with a start date of Monday, June 8, 2026* *UnitedHealth Group is not able to offer relocation assistance for this position* *UnitedHealth Group is not able to offer visa sponsorship now or in the future for this position* Required Qualifications: Currently in final year of obtaining a Bachelor's degree (or obtained degree no longer than 24 months prior to position start date, from an accredited college/university). Bachelor's Degree must be obtained prior to start of employment Must be eligible to work in the U.S. without company sponsorship, now or in the future, for employment-based work authorization (F-1 students with practical training and candidates requiring H-1Bs, TNs, etc. will not be considered) Preferred Qualifications: Work or volunteer experience in sales, customer service, health care, or health insurance Experience with Microsoft Office products (Word, Excel, PowerPoint, Outlook) Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 to $24.04 per hour based on full-time employment. This role is also eligible to receive bonuses based on sales performance. We comply with all minimum wage laws as applicable At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Internships at UnitedHealth Group. If you want an intern experience that will dramatically shape your career, consider a company that's dramatically shaping our entire health care system. UnitedHealth Group internship opportunities will provide a hands-on view of a rapidly evolving, incredibly challenging marketplace of ideas, products and services. You'll work side by side with some of the smartest people in the business on assignments that matter. So here we are. You have a lot to learn. We have a lot to do. It's the perfect storm. Join us to start Caring. Connecting. Growing together. At UHG, we've built focused businesses organized around one giant objective: making healthcare work better for everyone. Through our two business platforms, UnitedHealthcare (UHC) and Optum, we strive to improve the healthcare system and advance the health and well-being of individuals and communities. This includes the entire spectrum of healthcare participants: individual consumers, employers, commercial payers, intermediaries, physicians, hospitals, pharmaceutical and medical device manufacturers, and more. For you, that means working on high performance teams against sophisticated challenges. It's a culture of optimism that's unlike any place you've ever worked. Incredible ideas in one incredible company. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Are you ready? The UnitedHealth Group Leadership Experience (ULE) provides select participants pursuing advanced degrees with superior, cohort-based exposure, experiences, and development opportunities through best-in-class intern and full-time programs, specifically designed to develop the next generation of leaders, requiring highly motivated, passionate individuals with bright ideas and the will to lead. The ULE Internship is ten weeks long and delivered remotely, with the option to travel. Projects will vary by business and are scoped and assigned closer to Internship start. We offer full-time placement opportunities post-graduation, based on performance. The start date is June 2, 2026 During your ULE internship experience, you will: Lead high-priority work that supports one of our core businesses Gain exposure to and knowledge of the healthcare industry, Enterprise-wide businesses, functions, strategies, and senior leaders Develop relationships and networks Receive hands-on training and support Leverage business acumen and work experience to drive transformation Learn from and present to executives Contribute to fun and engaging cohorts Lay the groundwork for a meaningful and impactful career at UHG Examples of Intern projects: Build a comprehensive go-to-market strategy for UHG's Type-2 diabetes program for direct-to-consumer, risk-bearing entity (ACO), multi-payer, Medicare, and / or Medicaid channels Complete a market sizing analysis, including MVP definition and product / capability requirements for a new product in service of Optum's Health organizations and consumers Refine and implement the digital services plan for one of Optum's CDOs via the identification and strategic development of digital health initiatives and capabilities Comprehensive health equity strategy that reduces geographic health disparities and addresses specific populations' (ex. behavioral health, individuals of childbearing age) outcomes Market expansion strategy driven by data focused on geographical areas coupled with demographic information to make strategic decisions on smart growth through expansion, implementation and system readiness You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Undergraduate degree Currently pursuing an MBA or other relevant graduate degree with a target graduation date no later than July 2027 5+ years of previous professional work experience Eligible to work in the U.S. without company sponsorship, CPT/OPT now or in the future, for employment-based work authorization (F-1 students with practical training and candidates requiring H-1Bs, TNs, etc. will not be considered) Preferred Qualifications: Outstanding academic achievement Consulting and/or healthcare experience and/or involvement with consulting/healthcare clubs Excellent interpersonal, influencing and communication skills at all levels Practiced project management and navigating competing priorities Demonstrated ability to articulate and solve complex problems through strategic, analytical and creating thinking Adaptable and comfortable in ambiguity and high-impact situations High emotional intelligence and capacity to GSD (get stuff done) Champion of change and customer orientation Learning/growth oriented Aligned to UHG's values of Integrity, Compassion, Relationships, Innovation and Performance *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.