You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Supports the efforts of the clinical team through collaboration with prescribers and targeted beneficiaries in order to ensure appropriate, evidence-based drug selection and resolve medication-related problems. - Provides medication therapy management (MTM) services via triage of inbound calls to the MTM hotline, monitors fax line for prescriber responses and completion of failed faxes, supports the pharmacist for completion of Comprehensive Medication Reviews (CMRs) through pre-work up and case preparation, communicates with network pharmacies, prescribers, and beneficiaries to provide MTM services. - Documents and records services/activities in appropriate databases/software to ensure compliance with CMS requirements for clinical service offerings assigned in designated area. - Engages in drug utilization review (DUR) by supporting the execution of DUR initiatives via meeting preparation, letter campaigns, and telephonic outreach to members/providers. - Supports basic data analytic activities and tracking of interventions, and assists with preparation and documentation of responses to regulatory audits associated with the over utilization program. - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: High School or GED required, 0-1 year of experience in pharmacy operations managed care, hospitals, and/or retail environments. Licenses and Certifications: Certified Pharmacy Technician (CPhT) Preferred Location: Prefer candidate to live in KY. Hours: 8-5 EST Pay Range: $15.87 - $27.25 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Works with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction with members and providers at large IPA and/or group practices. Serves to collaborate with providers in the field, to improve HEDIS measures and provides education for HEDIS measures and coding. Supports the implementation of quality improvement interventions and audits in relation to plan providers. Assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS. Conducts telephonic outreach, while embedded in the providers' offices, to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements. Provides education to members regarding the care gaps they have when in the providers office for medical appointments. Schedules doctor appointments on behalf of the practitioner and assists member with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available. Maintains confidentiality of business and protected health information. - Acts as a liaison and member advocate between the member/family, physician and facilities/agencies. - Acts as the face of WellCare in the provider community with the provider and office staff where their services are embedded. - Advises and educates Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements. - Assesses provider performance data to identify and strategizes opportunities for provider improvement. - Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters). - Schedules doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider’s office. - Conducts face-to-face education with the member and their family, in the provider’s office, about care gaps identified, and barriers to care. - Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements. - Arranges transportation and follow-up appointments for member as needed. - Documents all actions taken regarding contact related to member. - Interacts with other departments including customer service to resolve member issues. - Refers to case or disease management as appropriate. - Completes special assignments and projects instrumental to the function of the department. - Performs other duties as assigned - Complies with all policies and standards This role requires approximately 25–30% travel to meet with providers within one the following Ohio communities: Dayton, Cambridge, Zanesville, Hillsboro, Troy, Greenville, Lima, Defiance, Marion, Mansfield, Wooster, Youngstown, Portsmouth, Chillicothe, Circleville, Wilmington, and Sidney. Preferred Qualifications - HEDIS quality improvement experience - Licensed Practical Nurse (LPN) credential preferred. Education/Experience: Required: a Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or equivalent work experience required (a total of 4 years of experience required for the position); work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment. 2+ years of experience work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment. License/Certification: One of the following is preferred. Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN) preferred. 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT Qualified candidate must reside in Harris County or surrounding areas within the state of Texas. Bilingual in English and Spanish highly preferred. Position Purpose: Serves as a vital link between members and the healthcare system, focusing on improving health outcomes by identifying and closing care gaps. This role emphasizes community engagement, member education, and collaboration with providers and internal teams to ensure members receive timely, appropriate care and support. - Conduct outreach to members in the community to identify care gaps and connect them with appropriate healthcare services and resources. - Perform home visits or community-based assessments to evaluate member needs and identify social determinants of health that may prevent members from accessing preventive or follow-up care, and facilitate care coordination. - Serve as a member advocate by helping individuals navigate complex healthcare and social service systems. Assist with scheduling appointments, understanding care plans, and accessing benefits or entitlements, ensuring members receive the support needed to close care gaps and maintain continuity of care - Collaborate with providers to share quality performance data (e.g., HEDIS, CAHPS) and support improvement initiatives. - Educate members on preventive care, chronic condition management, and available community resources. - Document member interactions, care gap closures, and referrals in the appropriate systems. - Partner with internal departments (e.g., Quality, Care Management, Provider Relations) to align efforts and improve member outcomes. - Monitor and report on outreach effectiveness and care gap closure metrics. - Maintain compliance with state and federal regulations and organizational policies. - Participate in seasonal campaigns and quality initiatives to improve member engagement and health outcomes. - Serve as a community ambassador, building relationships with local organizations and stakeholders. - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: Bachelor's Degree Social Work, Public Health, Nursing, or related field; or equivalent experience required 2+ years In community health or healthcare quality required Experience working with health plan members and navigating community resources required Familiarity with Medicaid / Medicare programs and quality measures (e.g., HEDIS) required Strong communication and interpersonal skills Licenses/Certifications: LCSW- License Clinical Social Worker preferred RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred Pay Range: $27.02 - $48.55 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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

Remote Representative – Build Long-Term Client Relationships Location: U.S. & Canada | 100% Remote Since 1951, AO has proudly supported working-class families by providing life, accident, and supplemental health products to members of labor unions, credit unions, associations, and their families. Our success is rooted in trust, service, and long-term relationships—and we continue to grow with stability and purpose. We’re seeking client-focused Remote Representatives to meet with families through Zoom-based virtual consultations, helping clients from the comfort of their homes while building lasting relationships in a fully remote environment. Why This Opportunity - Proven Stability: Over 20% company growth last year, even during challenging economic conditions - Essential Business: Long-term demand and security - Fully Remote: Work from anywhere in the U.S. or Canada - Client-Centered Role: Virtual meetings only—no in-person appointments Ideal Qualifications - Strong communication and relationship-building skills - Basic computer proficiency and comfort with virtual tools - Reliable work ethic and self-discipline - Outgoing, positive, and professional demeanor - Effective time management and organization - Leadership or management experience (preferred, not required) No prior insurance experience is required. Training and mentorship are provided. What We Offer - 100% Work From Home - Weekly Pay based on a proven schedule for success - Bonuses & Structured Contracts tied to performance - Health Insurance Reimbursement - Life Insurance Coverage - Flexible Schedule - Retirement Plan - Renewals & Residual Income for long-term earning potential Interview Process All interviews are conducted via Zoom video conferencing for safety and convenience.