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.
 

Remote to CA. Must have a CA License.

Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider physician injectable claims issues. Perform training, orientation and coaching for performance improvement within physician practices. Communicate effectively and partner with all internal departments to ensure members and providers have a positive, successful outcome.

• Serve as primary contact for providers serving as a liaison between the provider and the health plan for all pharmacy concerns
• Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on-site and routing to the appropriate party for resolution
• Receive and respond to provider related issues
• Recommend changes in pricing subsystems
• Attend weekly meetings with Case Management to assist where needed with pharmacy or medication concerns
• Educate providers regarding policies and procedures related to pharmacy issues; web site education, and problem solving (liaison responsibilities)
• Perform Provider orientations (includes writing/updating orientation material when necessary)
• Must have a good driving record and the ability to travel.

Education/Experience: Bachelor’s degree in Healthcare related field preferred. 3+ years of combined public relations and pharmacy related experience. Knowledge of health care, managed care, Medicare or Medicaid preferred. Claims billing/coding knowledge preferred.

License/Certification: Valid driver’s license. CPhT license 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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act