Jobs for People with MS: National MS Society

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position is REMOTE

Position Purpose: Responsible for the management of transplant and large dollar cases and oversight including compilation of clinical information, coordination of internal/external review and approvals, coordination with stop loss vendor, assisting with contract assignment and/or assignment to the approved transplant center, case monitoring, ongoing communication with transplant facility and the Plan’s assigned case manager, medical director, and organization finance department.

• Coordinate transplant requests from the pre-approval through claims payment processes within contractual or given timeframes

• Provide oversight of the transplant process, maintain timeframes and direct to most appropriate facility

• Coordinate transplant request and approval process with assigned medical directors

• Maintain oversight of case management activities at the health plan as related to finance goals on catastrophic cases for a broad range of conditions such as but not limited to, surgical, medical, neonatal complications, oncology, trauma or congenital conditions

• Act as organizational liaison with transplant contractor for approval and claim pricing

• Maintain transplant and catastrophic case logs and perform related Medical Management and Finance Department reporting

• Assist in the development and/or revision of necessary guidelines & protocols for transplant and catastrophic review and/or training

• Perform outlier claim review and analysis within contractual or given timeframes

• Facilitate and participate in transplant, catastrophic case or other assigned inter-departmental meetings

• Assist in the identification of trends, root causes, and provide recommendations for system improvements, manual process improvements, documentation and training

Education/Experience: 3+ of case management experience. Transplant, complex and/or catastrophic case management experience preferred. Proficient in the use of the Internet for research and Microsoft Office. AMYSIS and CCMS systems, claims review and medical coding experience desired.

License/Certification: Current state's RN or LPN license. Certified Case Manager (CCM) preferred.Pay Range: $25.97 - $46.68 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. Total compensation may also include additional forms of incentives.

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.