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The Senior Actuarial Analyst will develop and maintain models for pricing and filing of Centene's marketplace product, Ambetter Health. Responsibilities include leading model operations, communicating results, developing standalone and integrated sub-models, analyzing data, and creating visualizations.
The Retention Field Representative is responsible for retaining membership in an assigned territory through telephonic and field outreach. Responsibilities include educating members about programs, assisting at community events, conducting follow-up calls, and ensuring compliance with policies. They must meet quality assurance standards and maintain relationships with existing members.
The Quality Program Strategist II will oversee quality improvement programs for HEDIS, CAHPS, and HOS strategies, analyze business issues for stakeholders, develop support resources, ensure compliance with state reporting standards, and train Quality Improvement Health Plan staff.
The Community Resource Coordinator II position supports community connection activities to help members access resources for their care management. Responsibilities include outreach, health assessments, and documentation of community resources while assisting clinical teams and promoting awareness of available services.
The Senior Power Application Engineer designs, develops, and implements complex enterprise software solutions while collaborating with various technical and non-technical roles. Responsibilities include creating and testing software modules, analysing user needs, and providing application support. The role also requires assessing architectural impacts from business requirements and leading project efforts for improved application functionality.
As a Community Resource Coordinator III, you will connect members with community resources to enhance their care management journey. Your responsibilities include documenting resources, supporting outreach efforts, conducting assessments, and collaborating with care management teams to ensure members receive necessary services. Travel within the Houston area is required for home visits.
The Complex Discharge Planner coordinates and develops discharge plans for high-risk members, ensuring a smooth transition between acute care and subsequent levels of care. They interact with various healthcare providers, educate members on discharge processes, and maintain documentation per management policies.
As a Grievance & Appeals Coordinator, you'll analyze and resolve claims and authorization appeals from providers, tackle formal grievances from members, maintain organized records, prepare official correspondence, and assist with data entry and HEDIS functions while managing documentation efficiently.
The Community Resource Coordinator III connects members to community resources, supports care management activities, conducts health and non-medical assessments, provides education, and collaborates with the care team to promote member well-being. This role involves both outreach and documentation to ensure effective resource connection and may include home visits and telephonic engagement.
The Resource Coordinator II will support community connection activities by connecting members to resources for care management, coordinating outreach efforts, providing health education, documenting community resources, assisting clinical teams, and conducting health assessments. The role includes telephonic and in-person outreach to promote awareness of available resources and requires compliance with health plan policies.
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