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 POSITION IS FULLY REMOTE/WORK FROM HOME. TRAINING WORK SCHEDULE IS MONDAY-FRIDAY 8AM - 5PM CENTRAL TIME ZONE. THE WORK SCHEDULE AFTER TRAINING IS TUESDAY - SATURDAY 8AM - 5PM CENTRAL TIME ZONE. Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. - Gather, analyze and report verbal and written member and provider complaints, grievances and appeals - Prepare response letters for member and provider complaints, grievances and appeals - Maintain files on individual appeals and grievances - May coordinate the Grievance and Appeals Committee - Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information - Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research. - Manage large volumes of documents including copying, faxing and scanning incoming mail - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims, related managed care experience, or relevant experience. Pay Range: $19.43 - $32.98 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

We're looking for Nurse Care Managers for our Care and Case Management team, who are passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading interventions. As a telephonic Nurse Care Manager you will report to the Manager, Care and Case Management and will guide members through complex medical and behavioral Health situations, partnering with a diverse clinical team that includes a variety of healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care in a creative way. The Nurse Care Manager should enjoy spending time on the phone, listening to members' needs, answering questions, and serving as an advocate. You will excel at creating cohesive care plans, and have the clinical skills to guide members clinically and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes. #LI-Remote Responsibilities: - Deliver coordinated, patient-centered virtual Care Management by telephone or video that improves members' health outcomes. - Create impactful care plans together with members and our diverse care team, and help members achieve the desired goals. - Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general. - Partner with the members' local providers to ensure coordinated care. - Provide compassionate, longitudinal follow-up care, building supportive relationships. - Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family. - Coordinate necessary resources that holistically address members' problems, whether clinical or social Qualifications: - Bachelor of Science in Nursing (BSN). - 5+ years of experience in nursing - 2+ years experience working in care management - Must reside in a compact NLC state. - Active Compact RN license in good standing with the nursing board of their state. - Willingness to become (and maintain) licensure in multiple states. - Work until 9-6PM PST - Be comfortable discussing several medical conditions and experience with populations across the age ranges - Spanish speaking desirable - Experience working remotely, and strong competence and ability to use multiple computer/medical record systems. - Be empathetic. We work with patients and their families who are going through challenging times. You practice empathy and reassure patients that we are available to help them. - We are a fast-growing company and we are busy. Our team will meet volume goals without sacrificing quality. - Strictly follow security and HIPAA regulations to protect our patients' medical information. - Be pleasant, responsive, and willing to work with and learn from our team. - A lot of time is spent on the phone with patients and families, and a lot of time communicating with colleagues. Therefore, the ability to gather a clinical history, answer questions at a patient level, and summarize findings is critical. - Efficient at writing medical information in easy-to-understand, patient-centric language. Physical/Cognitive Requirements - Prompt and regular attendance at assigned work location. - Capability to remain seated in a stationary position for prolonged periods. - Eye-hand coordination and manual dexterity to operate keyboard, computer and other office-related equipment. - No heavy lifting is expected, though occasional exertion of about 20 lbs of force (e.g., lifting a computer \/ laptop) may be required. - Capability to work with leadership, employees, and members in an appropriate manner. The United States new hire base salary target range for this full-time position is: $73,700 - $103,180 + equity + benefits This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health's commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones. Starting base salary for you will depend on several job-related factors, unique to each candidate, which may include education; training; skills; years and depth of experience; certifications and licensure; our needs; internal peer equity; organizational considerations; and understanding of geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and great compensation package based on their roles and locations. Your Recruiter can share your geographic zone upon inquiry. Benefits & Perks: In addition to receiving a great compensation package, the compensation package may include, depending on the role, the following and more: Remote-first culture 401(k) savings plan through Fidelity Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance) Paid Time Off ("PTO") and Discretionary Time Off ("DTO") 12 weeks of 100% Paid Parental leave Family Building & Compassionate Leave: Fertility coverage, $25,000 for surrogacy/adoption, and paid leave for failed treatments, adoption or pregnancies. Work-From-Home reimbursement to support team collaboration home office work Your recruiter will share more about the salary range and benefits package for your role during the hiring process. About Included Health Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com. ----- Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.

Location Address: 4580 Paradise Blvd NW Albuquerque, NM 87114-4105 Type of Opportunity: Part time FTE: 0.50 Summary: Provide primary care services to patients, emphasizing health promotion and disease prevention. Diagnose and manage acute and chronic diseases. Services include obtaining pertinent history, performing examinations, ordering and interpreting appropriate laboratory tests and prescribing appropriate medic Job Description: Responsibilities: - Takes a history, performs assessment, forms a diagnosis, develops plan of care, and assures follow-up of patients. - Primary health care providers, emphasizing health promotion and disease prevention. - Manages acute and chronic diseases. - Orders, conducts, and interprets appropriate diagnostic x-ray and lab tests. - Prescribes treatments, medications, and non-pharmacologic therapies. - Involved in teaching and counseling individuals, families, and groups. - Works autonomously, as well as collaborate with other health care providers as needed. - Serves as health care resources, interdisciplinary consultants and patient advocate. - Performs other functions as required Additional Job Description: The minimum requirements are as follows: For Nurse Practitioner - Masters degree in Nursing, New Mexico Nurse Practitioner license, federal and state DEA license and ANCC certification required. Minimum of one year experience preferred but not required For Physician Assistant - Baccalaureate prepared CAHEA Certified Physician Assistant or two (2) years working experience as a Certified Physician Assistant, and licensed by the New Mexico Board of Medical Examiners required. Minimum of one year experience preferred but not required We offer more than the standard benefits! Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more! In addition, we offer all employees a robust, day one effective benefits plan consisting of medical, dental, vision and more. Exceptional retirement plans - 403b retirement savings program with both matching programs and employer contributions. Learn more about our employee benefits Presbyterian is not just a great place to practice medicine, it's where you'll find a different way to make a difference. Our commitment to safe, high-quality care is at the heart of everything we do. Here's a glimpse of what sets us apart: - Technology and digital platforms allow our clinicians to focus on meaningful work and reduce friction in your practice. - Innovative care models improve access and free providers to focus on our patients. Clinicians spend more time connecting patients with affordable, innovative solutions that keep them healthy. - All employees have a Strongline silent alarm badge to help you be - and feel -- safer at work. - The RESET program is a multi-day immersive retreat designed for clinicians, fostering personal and professional growth. Through interactive sessions, self-reflection, and peer support, participants gain insights, tools, and practices to enhance well-being, resilience, and intentional living. About Presbyterian Healthcare Services: Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with over 14,000 employees - including 1,200 providers and 4,000 nurses. Our health plan serves more than 600,000 members statewide and offers Medicare Advantage, Medicaid and Commercial health plans. About Our Regional Delivery System Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities. Living and Working in New Mexico Beyond the professional advantages, living in New Mexico offers a unique blend of culture, outdoor adventures, and a diverse community. - Cultural richness. Immerse yourself in the cultural richness of New Mexico, from historic adobe structures to vibrant festivals celebrating our diverse heritage. - Outdoor paradise. With over 300 days of sunshine annually, indulge in outdoor activities ranging from hiking the Sandia Mountains to skiing in nearby Taos. - Community spirit. Our communities are known for their warmth and hospitality, making your transition seamless and enjoyable. - Learn more about New Mexico AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses

Location Address: 4580 Paradise Blvd NW Albuquerque, NM 87114-4105 Type of Opportunity: Part time FTE: 0.50 Summary: Provide primary care services to patients, emphasizing health promotion and disease prevention. Diagnose and manage acute and chronic diseases. Services include obtaining pertinent history, performing examinations, ordering and interpreting appropriate laboratory tests and prescribing appropriate medic Job Description: Responsibilities: - Takes a history, performs assessment, forms a diagnosis, develops plan of care, and assures follow-up of patients. - Primary health care providers, emphasizing health promotion and disease prevention. - Manages acute and chronic diseases. - Orders, conducts, and interprets appropriate diagnostic x-ray and lab tests. - Prescribes treatments, medications, and non-pharmacologic therapies. - Involved in teaching and counseling individuals, families, and groups. - Works autonomously, as well as collaborate with other health care providers as needed. - Serves as health care resources, interdisciplinary consultants and patient advocate. - Performs other functions as required Additional Job Description: The minimum requirements are as follows: For Nurse Practitioner - Masters degree in Nursing, New Mexico Nurse Practitioner license, federal and state DEA license and ANCC certification required. Minimum of one year experience preferred but not required For Physician Assistant - Baccalaureate prepared CAHEA Certified Physician Assistant or two (2) years working experience as a Certified Physician Assistant, and licensed by the New Mexico Board of Medical Examiners required. Minimum of one year experience preferred but not required We offer more than the standard benefits! Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more! In addition, we offer all employees a robust, day one effective benefits plan consisting of medical, dental, vision and more. Exceptional retirement plans - 403b retirement savings program with both matching programs and employer contributions. Learn more about our employee benefits Presbyterian is not just a great place to practice medicine, it's where you'll find a different way to make a difference. Our commitment to safe, high-quality care is at the heart of everything we do. Here's a glimpse of what sets us apart: - Technology and digital platforms allow our clinicians to focus on meaningful work and reduce friction in your practice. - Innovative care models improve access and free providers to focus on our patients. Clinicians spend more time connecting patients with affordable, innovative solutions that keep them healthy. - All employees have a Strongline silent alarm badge to help you be - and feel -- safer at work. - The RESET program is a multi-day immersive retreat designed for clinicians, fostering personal and professional growth. Through interactive sessions, self-reflection, and peer support, participants gain insights, tools, and practices to enhance well-being, resilience, and intentional living. About Presbyterian Healthcare Services: Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with over 14,000 employees - including 1,200 providers and 4,000 nurses. Our health plan serves more than 600,000 members statewide and offers Medicare Advantage, Medicaid and Commercial health plans. About Our Regional Delivery System Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities. Living and Working in New Mexico Beyond the professional advantages, living in New Mexico offers a unique blend of culture, outdoor adventures, and a diverse community. - Cultural richness. Immerse yourself in the cultural richness of New Mexico, from historic adobe structures to vibrant festivals celebrating our diverse heritage. - Outdoor paradise. With over 300 days of sunshine annually, indulge in outdoor activities ranging from hiking the Sandia Mountains to skiing in nearby Taos. - Community spirit. Our communities are known for their warmth and hospitality, making your transition seamless and enjoyable. - Learn more about New Mexico AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses