Description Position Purpose Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts. Provide advanced analytical support for business operations in all or some of the following areas claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting Extract, load, model, and reconcile large amounts of data across multiple system platforms and sources Review data to determine operational impacts and needed actions elevate issues, trends, areas for improvement and opportunities to management. Develop reports and deliverables for management Model data using MS Excel, Access, SQL, andor other data ware house analytical tools Ensure compliance with federal and state deliverable reporting requirements by performing data quality audits and analysis. Assist with training and mentoring other Data Analysts. Qualifications EducationExperience Bachelor s degree in related field or equivalent experience. 4+ years of statistical analysis or data analysis experience. Healthcare experience preferred. Advanced knowledge of Enterprise Reporting and Analysis tools, SQL, and Microsoft Office applications, including Excel and Access. Experience managing projects or heavy involvement in project implementation. BUSINESS ANALYTICS Bachelor s degree in related field or equivalent experience. 4+ years of statistical analysis or 2+ years of related IT experience, including data warehouse, coding or ETL experience. Healthcare experience preferred. Advanced knowledge of Enterprise Reporting and Analysis tools, SQL, and Microsoft Office applications, including Excel and Access. Experience managing projects or heavy involvement in project implementation. Encounters experience 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.
Mar 26, 2020
Full time
Description Position Purpose Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts. Provide advanced analytical support for business operations in all or some of the following areas claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting Extract, load, model, and reconcile large amounts of data across multiple system platforms and sources Review data to determine operational impacts and needed actions elevate issues, trends, areas for improvement and opportunities to management. Develop reports and deliverables for management Model data using MS Excel, Access, SQL, andor other data ware house analytical tools Ensure compliance with federal and state deliverable reporting requirements by performing data quality audits and analysis. Assist with training and mentoring other Data Analysts. Qualifications EducationExperience Bachelor s degree in related field or equivalent experience. 4+ years of statistical analysis or data analysis experience. Healthcare experience preferred. Advanced knowledge of Enterprise Reporting and Analysis tools, SQL, and Microsoft Office applications, including Excel and Access. Experience managing projects or heavy involvement in project implementation. BUSINESS ANALYTICS Bachelor s degree in related field or equivalent experience. 4+ years of statistical analysis or 2+ years of related IT experience, including data warehouse, coding or ETL experience. Healthcare experience preferred. Advanced knowledge of Enterprise Reporting and Analysis tools, SQL, and Microsoft Office applications, including Excel and Access. Experience managing projects or heavy involvement in project implementation. Encounters experience 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.
Position Purpose: Serve as the primary contact in providing customer service and technical support to internal partners and vendors with complex issues. Act as a technical resource for other IT Support Specialists. Design, build and/or test new systems, processes or services Respond to requests for new services Document workflow of processes within the organization Investigate, research and troubleshoot complex IT related issues Identify training needs, perform new user IT training and communication of IT policies and standards Perform scheduled departmental audits and report findings to management Act as a technical resource for other IT Support Specialists Education/Experience: High School diploma or equivalent. Bachelor's degree in Computer Science, MIS or related field preferred. 3+ years of related experience. Required:Operating system and desktop productivity software knowledge (ie XP, Win 7, MS Office 2007/10, McAfee, SCCM, etc.) to provide desktop support. Solid foundation with the installation & support of relevant hardware (ie Laptops, Thin Clients, Desktops, printers, etc.). Able to multitask and adapt to a high call volume environment. 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.
Mar 26, 2020
Full time
Position Purpose: Serve as the primary contact in providing customer service and technical support to internal partners and vendors with complex issues. Act as a technical resource for other IT Support Specialists. Design, build and/or test new systems, processes or services Respond to requests for new services Document workflow of processes within the organization Investigate, research and troubleshoot complex IT related issues Identify training needs, perform new user IT training and communication of IT policies and standards Perform scheduled departmental audits and report findings to management Act as a technical resource for other IT Support Specialists Education/Experience: High School diploma or equivalent. Bachelor's degree in Computer Science, MIS or related field preferred. 3+ years of related experience. Required:Operating system and desktop productivity software knowledge (ie XP, Win 7, MS Office 2007/10, McAfee, SCCM, etc.) to provide desktop support. Solid foundation with the installation & support of relevant hardware (ie Laptops, Thin Clients, Desktops, printers, etc.). Able to multitask and adapt to a high call volume environment. 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.
Position Purpose: Serve as the primary contact in providing customer service and technical support to internal partners and vendors with complex issues. Act as a technical resource for other IT Support Specialists. Design, build and/or test new systems, processes or services Respond to requests for new services Document workflow of processes within the organization Investigate, research and troubleshoot complex IT related issues Identify training needs, perform new user IT training and communication of IT policies and standards Perform scheduled departmental audits and report findings to management Act as a technical resource for other IT Support Specialists Education/Experience: High School diploma or equivalent. Bachelor's degree in Computer Science, MIS or related field preferred. 3+ years of related experience. Required:Operating system and desktop productivity software knowledge (ie XP, Win 7, MS Office 2007/10, McAfee, SCCM, etc.) to provide desktop support. Solid foundation with the installation & support of relevant hardware (ie Laptops, Thin Clients, Desktops, printers, etc.). Able to multitask and adapt to a high call volume environment. 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.
Mar 25, 2020
Full time
Position Purpose: Serve as the primary contact in providing customer service and technical support to internal partners and vendors with complex issues. Act as a technical resource for other IT Support Specialists. Design, build and/or test new systems, processes or services Respond to requests for new services Document workflow of processes within the organization Investigate, research and troubleshoot complex IT related issues Identify training needs, perform new user IT training and communication of IT policies and standards Perform scheduled departmental audits and report findings to management Act as a technical resource for other IT Support Specialists Education/Experience: High School diploma or equivalent. Bachelor's degree in Computer Science, MIS or related field preferred. 3+ years of related experience. Required:Operating system and desktop productivity software knowledge (ie XP, Win 7, MS Office 2007/10, McAfee, SCCM, etc.) to provide desktop support. Solid foundation with the installation & support of relevant hardware (ie Laptops, Thin Clients, Desktops, printers, etc.). Able to multitask and adapt to a high call volume environment. 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.
HourlyPosition Purpose: The Utilization Review Nurse I provides first level clinical review for all outpatient and ancillary services requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a professional and competent manner. Processes all prior authorizations to completion utilizing appropriate review criteria. Identifies and refers all potential quality issues to the Clinical Quality Management Department, and suspected fraud and abuse cases to Program Integrity. Acts as liaison between the TRICARE beneficiary and the Network Provider. + Provides first level RN review for all outpatient and ancillary prior authorization requests for medical appropriateness and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and determination. Completes data entry and correspondence as necessary for each review. + Conducts rate negotiation with non-network providers, utilizing appropriate CMAC, DRG, HCPC reimbursement methodologies. Documents rate negotiation accurately for proper claims adjudication. + Acts as liaison between the TRICARE beneficiary and the provider, facility and the MTF to utilize appropriate and cost effective medical resources within the direct care and purchased care system. + Identifies and refers potential cases to Disease Management, Case Management, Demand Management and Transitional Care. + Refers all potential quality issues and grievances to Clinical Quality Management and suspected fraud and abuse to Program Integrity. Education/Experience: Graduate of Nursing program; BSN desired or Graduate in Clinical Psychology or Clinical Social Work. Three years clinical experience in a health care environment; managed care experience desired. NY licensed RN highly preferred. For Fidelis Care only: NYS RN, OT or PT license required _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._ **TITLE:** Utilization Review Nurse I **LOCATION:** Getzville, New York **REQNUMBER:** **COMPANY:** Medical Management **POSITION TYPE:** Hourly
Mar 24, 2020
Full time
HourlyPosition Purpose: The Utilization Review Nurse I provides first level clinical review for all outpatient and ancillary services requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a professional and competent manner. Processes all prior authorizations to completion utilizing appropriate review criteria. Identifies and refers all potential quality issues to the Clinical Quality Management Department, and suspected fraud and abuse cases to Program Integrity. Acts as liaison between the TRICARE beneficiary and the Network Provider. + Provides first level RN review for all outpatient and ancillary prior authorization requests for medical appropriateness and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and determination. Completes data entry and correspondence as necessary for each review. + Conducts rate negotiation with non-network providers, utilizing appropriate CMAC, DRG, HCPC reimbursement methodologies. Documents rate negotiation accurately for proper claims adjudication. + Acts as liaison between the TRICARE beneficiary and the provider, facility and the MTF to utilize appropriate and cost effective medical resources within the direct care and purchased care system. + Identifies and refers potential cases to Disease Management, Case Management, Demand Management and Transitional Care. + Refers all potential quality issues and grievances to Clinical Quality Management and suspected fraud and abuse to Program Integrity. Education/Experience: Graduate of Nursing program; BSN desired or Graduate in Clinical Psychology or Clinical Social Work. Three years clinical experience in a health care environment; managed care experience desired. NY licensed RN highly preferred. For Fidelis Care only: NYS RN, OT or PT license required _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._ **TITLE:** Utilization Review Nurse I **LOCATION:** Getzville, New York **REQNUMBER:** **COMPANY:** Medical Management **POSITION TYPE:** Hourly
HourlyPosition Purpose: Conduct assessments of callers' presenting symptoms. Develop, implement, and evaluate a plan of care for each caller presenting symptoms. Answer all calls in a timely manner. Maintain confidentiality of all caller and personnel issues. Document all call inquiries according to department policies and procedures. Participate in the collection of data for department quality projects. Promote recovery concepts and inspire hope. Possess and maintain a thorough grasp of clinical knowledge pertaining to various disease states, medications, treatments, etc. Comply with Federal and respective state's laws regulating health management organizations and telephone information centers and all department standards and policies and procedures. Apply primary nursing knowledge while performing all aspects of assigned tasks.Triage inbound calls, gather information, select appropriate triage guidelines, and disposition and care advice based on database protocols and department policies and procedures for a 24 hour per day/7 day a week operation. Provide clinical information and education for inbound and outbound calls providing oversight and support to the non-clinical staff. Education/Experience: Graduate certificate from an accredited nursing program. 3+ years combined experience in critical care, pediatric, obstetrics, home health, school nursing, or emergency nursing. 5 years experience strongly preferred. Licenses/Certifications: Current RN license without restriction in state of residence. *Work from home position that can be based anywhere in United States* _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._ **TITLE:** TeleHealth Registered Nurse (Registry) Per Diem/ Remote **LOCATION:** El Paso, Texas **REQNUMBER:** **COMPANY:** Clinical & Nursing **POSITION TYPE:** Hourly
Mar 24, 2020
Full time
HourlyPosition Purpose: Conduct assessments of callers' presenting symptoms. Develop, implement, and evaluate a plan of care for each caller presenting symptoms. Answer all calls in a timely manner. Maintain confidentiality of all caller and personnel issues. Document all call inquiries according to department policies and procedures. Participate in the collection of data for department quality projects. Promote recovery concepts and inspire hope. Possess and maintain a thorough grasp of clinical knowledge pertaining to various disease states, medications, treatments, etc. Comply with Federal and respective state's laws regulating health management organizations and telephone information centers and all department standards and policies and procedures. Apply primary nursing knowledge while performing all aspects of assigned tasks.Triage inbound calls, gather information, select appropriate triage guidelines, and disposition and care advice based on database protocols and department policies and procedures for a 24 hour per day/7 day a week operation. Provide clinical information and education for inbound and outbound calls providing oversight and support to the non-clinical staff. Education/Experience: Graduate certificate from an accredited nursing program. 3+ years combined experience in critical care, pediatric, obstetrics, home health, school nursing, or emergency nursing. 5 years experience strongly preferred. Licenses/Certifications: Current RN license without restriction in state of residence. *Work from home position that can be based anywhere in United States* _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._ **TITLE:** TeleHealth Registered Nurse (Registry) Per Diem/ Remote **LOCATION:** El Paso, Texas **REQNUMBER:** **COMPANY:** Clinical & Nursing **POSITION TYPE:** Hourly
