Medical Management Operations Specialist

Centene Corporation Clayton , MO 63105

Posted 4 weeks ago

Position Purpose: Collaborate between Medical Management and business partners to develop and communicate policies and processes within medical management to ensure continuity of Medical Management business to all associated partners, departments, and functional areas.

  • Support health plan and maintain best practices within Medical Management departments; provide support during new business implementations and maintain continuity

  • Maintain and execute yearly IRR (interrater reliability), development of testing questions, summary of changes, yearly recertification, and collaborate with installation of new criteria

  • Develop, collaborate and communicate best practices within Medical Management

  • Coordinate to implement initiatives and determine issues and help develop and execute corrective action plans based on best practice recommendations to facilitate process improvement

  • Review, update and maintain Medical Management workflow library

  • Establish and outline best practices, new standards and tools within Medical Management functional areas

  • Provide updates on Medical Management business related content to Centene University to ensure content related to Medical Management business is maintained, updated, relevant, clearly communicated and understood

  • Maintain and establish work process continuity for Ambetter/Medicare/ Medicaid and long term support services

Education/Experience:

  • Bachelor's degree or equivalent experience
  • 2 years of experience in medical management, managed care Industry, training health insurance, or operations

License/Certification:

Clinical licensure preferred

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.


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Medical Management Operations Specialist

Centene Corporation