Job Description
Centene Corporation is a leading multi-line healthcare enterprise that provides managed-care programs and related services to individuals receiving benefits under Medicaid, including Supplemental Security Income (SSI) and the State Children’s Health Insurance Program (SCHIP). Position Purpose:
Perform duties to assist upper management in supervising the day-to-day work function of a 24/7 medical/behavioral health call center that provides health plans, provider organizations and other clients with various telephonic services. Knowledge/Experience:
Registered Nurse with a thorough knowledge of a specialized or technical field such as clinical nursing, managed care, business administration involving thorough skills knowledge and the application of basis theory. 3-5 years experience in medical and/or behavioral health. At least 3 years healthcare or managed care experience. At least 1 year of supervisor or lead experience. Thorough skills knowledge of medical information systems, claims processing systems, medical terminology, and eligibility and benefits of a managed care plan, preferably Medicaid. 1-3 years call center experience preferred. Position Responsibilities: Oversee the work flow of the department and communicate standards.
Perform direct supervision of staff, to include clinical reviews.
Assist with the development, revision and communication of Policies and Procedures.
Develop, implement and maintain production and quality standards for the staff.
Participate in interactions with all internal and external stakeholders to the organization.
Participate in process re-design efforts including technology enhancements or implementations.
Research and articulate “best practices” in the industry.
Support integration of other acquisitions.
Ensure that staff applies primary knowledge while performing all aspects of assigned tasks.
Work with Clinical management staff to ensure that thorough and sound clinical assessments of callers presenting symptoms are conducted.
Ensure that staff develop, implement, and evaluate a plan of care for each caller presenting symptoms and answer all calls in a timely and courteous manner.
Maintain confidentiality of all caller and personnel issues.
Respond to complaints in a timely manner.
Ensure documentation of all call inquiries according to department policies and procedures.
Direct the collection of data for department QI/QA projects.
Ensure submission of client reports per agreed upon schedule.License/Certificates: Licensed Registered Nurse
Job Requirements
Communication Skills,Flexible hours
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