Position Purpose: Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.
Initiate authorization requests for output or input services in keeping with the prior authorization list
Maintain integrity of PHI and working relationships with other departments
Research claims inquiry specific to the department and responsibility
Attend ongoing training and inservices as directed, and perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results
Assess and monitor inpatient census and screen for eligibility and benefits
Identify members without a PCP and refer to Member Services and answers phone queues and faxes within established standards
Coordinates services with community based organizations, and attend marketing and outreach meetings as directed to represent the plan
Produces and mails routine CM letters and program educational materials, and assist develop marketing and outreach meetings as directed to represent the health plan
Train new Program Coordinators on system and usage and guide staff regarding benefits, authorization requirements and policy and procedures
Data enter assessments and authorizations into the system and maintain database as directed
Education/Experience: High school diploma or equivalent; 3-5 years managed care or physician's office experience.
Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.
Licenses/Certifications: LPN license highly 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.