Plan Design Specialist jobs in Killeen, TX

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.

This is a remote position. Candidate must reside in Texas.

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. Maintain working relationships with other departments. Research claims inquiry specific to the department and responsibility. Attend ongoing training and inservices as directed. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.
• Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Answers phone queues and faxes within established standards. Screen members by priority for CM assessment.
• Coordinates services with community based organizations. Attends marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material. Helps develop marketing and outreach meetings as directed to represent the health plan.
• Train new Program Coordinators on system and usage. Guide staff regarding benefits, authorization requirements and policy and procedure.
• Data enters assessments and authorizations into the system. Maintains database as directed.

Education/Experience: High school diploma or equivalent; 3-5 years managed care setting, medical office or facility setting with demonstration of medical administration duties. 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.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.

About the Company:
Superior Health Plan