Lead, Coordinated Care Programs (Remote‑Friendly)

Dev; Tulsa (OK); Hybrid; USD 65,000 - 95,000; Full time

Job summary

Centene Corporation in Oklahoma is seeking a clinical professional to lead development and implementation of Coordinated Care programs (OB/NICU, Asthma, Diabetes, ER, General/Catastrophic) and to supervise quality and continuity of services for Members, Providers and staff.

You will collaborate across departments to extract data, develop education components, and oversee contract negotiations for PNCC entities, ensuring program success and positive outcomes.

Qualifications

• High school diploma or equivalent.
• 5+ years of prior authorization, physician's office, customer service, claims processing or provider relations experience preferably in a managed care setting.
• Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.

Responsibilities

• Develop and oversee aspects of coordinated care program activities
• Develop and implement management software and reporting mechanisms for specific outcome measurement and data reporting
• Identify referrals for coordinated care programs.
• Develop plan specific literature and educational components for member and provider distribution.
• Oversee contract negotiation and execution components for Prenatal Coordinated Care (PNCC) entities
• Collaborate with various departments to extract data for identification of program members and to report program outcomes
• Identify processes and work flow improvements to foster efficient and effective case management efforts
• Monitor distribution of members identified for case management to ensure positive results and program success

Skills

Prior authorization

Customer service

Claims processing

Provider relations

Team leadership

Education

High school diploma

Job description

Centene Corporation in Oklahoma is seeking a clinical professional to lead development and implementation of Coordinated Care programs (OB/NICU, Asthma, Diabetes, ER, General/Catastrophic) and to supervise quality and continuity of services for Members, Providers and staff.

You will collaborate across departments to extract data, develop education components, and oversee contract negotiations for PNCC entities, ensuring program success and positive outcomes.