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. Position Purpose: Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access. - Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines. - Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination. - Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment. - Performs data entry to maintain and update various authorization requests into utilization management system. - Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer. - Remains up-to-date on healthcare, authorization processes, policies and procedures. - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 years of related experience. Knowledge of medical terminology and insurance preferred. Pay Range: $17.84 - $28.02 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 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. Superior Health Plan - Specialty Therapy Services NOTE: Candidates must reside in the state of Texas Position Purpose: Perform utilization review of authorization requests regarding specialty therapy services for members, including speech language, occupational, and physical therapy across the identified regions and products. Assist with training and network management support for therapy providers. - Perform detailed review of therapy service requests based on evidenced based practice, documentation standards as indicated by the national therapy associations, and organizational policies. - Refer members to case management as appropriate based on service request assessment. - Provide clinical recommendations for any adverse therapy determination. - Provide clinical expertise based on shared practice standards regarding sub-specialty therapy practice to peers. - Provide support for specialty therapy providers, including assistance with clinical trainings, consultation and guidance on matters related to therapy authorization and provision. - Provide clinical expertise to multi-functional areas within organization to support provider relations and operations. - Performs other duties as assigned - Complies with all policies and standards Education/Experience: Master’s degree in area of specialty therapy or equivalent experience. 3+ years of experience providing therapy services in healthcare or home health settings. Pediatric clinical experience preferred. Licenses/Certifications: Current state license in Physical Therapy, Occupational Therapy or Speech-Language Therapy. Speech-Language Therapist must have an active Certificate of Clinical Competence from the American Speech-Language-Hearing Association. Pay Range: $33.71 - $60.67 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

Department: 10136 Enterprise Corporate - Clinical Data Registry Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Full time (40 hours per week). Remote position. This is a remote, work from home position. Due to complex requirements, remote work is NOT permitted in: CA, DC, CO, CT, HI, MA, MD, MN, ND, NJ, NY, OR, RI, VT, WA and working Internationally.* Pay Range $26.55 - $39.85 Responsible for collecting, abstracting, coding, analyzing, reporting and following the current and retrospective patients who meet the inclusion criteria for the data registries that are required by the organization, mandated by the state, and or national accrediting bodies. Provides high-quality data for monitoring and reporting to internal market groups, clinicians, researchers and accrediting bodies to benchmark and evaluate patient care compliance with evidence-based quality metrics. Creates reports to accurately portray organizational volumes and to evaluate performance for medical staff and system committees as requested. Coordinates and supports prospective multi-disciplinary case conferences. Acts as a liaison between hospital facilities, external accrediting agencies, physicians, state department of health and human services, data vendors and technical support. Success is accomplished by accurate, complete and timely data that may be used to improve patient care and organizational performance. Major Responsibilities: - Performs review of complex clinical records to secure data for inclusion into the formal longitudinal registries required by the organization. - Uses appropriate classification and coding systems via computerized software, within the time frames required by local, state and national mandates. - Abstracts high integrity information from the internal medical record and conducts concurrent and or retrospective review of external medical records in order to facilitate complete analysis, monitoring and reporting of quality data. - Performs interoperability and reliability testing and utilizes various data quality monitoring techniques to reconcile and validate information according to registry and internal data quality standards and data dictionaries. - Completes the process for timely submission of data at appropriate intervals to the various advanced and complex disease/procedure specific specialty databases and other registries as required for compliance with membership and professional standards. Coordinates multi-disciplinary weekly case conferences, preparing notices, summations and submits all required Continuing Professional Development department post-conference documentation for CME. - Develops, performs, and evaluates quality improvement activities for the registries ensuring a percent of abstracted data is physician and peer reviewed on an annual basis. - Performs follow-up of appropriate registry patients over their lifetime as required, maintaining the accuracy and integrity of the data for use in end-results, financial, market, research and quality reporting. - Establishes and maintains effective working relationships with physicians and care management staff working together to compile registry data into meaningful reports/displays and promotes the use and visibility of the information collected. - Prepares and assists with studies for publication, audits, and annual reports in a timely fashion. - Prepares and assists in developing and updating Registry "Policies and Procedures" on a yearly basis and complies with accrediting agency requirements. Licensure, Registration, and/or Certification Required: - None Required. Education Required: - Associate degree in health information management or related field (or if working in Cancer Registry, enrollment in Associate degree program and ready to start practicum). Experience Required: - Typically requires 1 year of experience in data collection that includes experiences in coding/abstracting and clinical documentation. Knowledge, Skills & Abilities Required: - Knowledge of medical terminology, anatomy and physiology and pathophysiology. - Knowledge of computer applications, computer function and basic statistical methods. - Ability to follow detailed coding instructions and specifications with minimal supervision. - Ability to work independently with a high degree of accuracy and attention to detail. - Ability to communicate well orally and in written format. - Ability to travel as needed with exposure to road and weather conditions. - Ability to spend extended periods of time (75% of the workday) in sedentary work. - Ability to operates all equipment necessary to perform the job. - Ability to secure required credentials according to internal and external requirements for abstraction. - Exposed to a normal office environment. Physical Requirements and Working Conditions: - Exposed to a normal office environment. - Exposure to road and weather conditions. - Ability to spend extended periods of time (75% of the workday) in sedentary work. - Operates all equipment necessary to perform the job. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation - Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training - Premium pay such as shift, on call, and more based on a teammate's job - Incentive pay for select positions - Opportunity for annual increases based on performance Benefits and more - Paid Time Off programs - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability - Flexible Spending Accounts for eligible health care and dependent care expenses - Family benefits such as adoption assistance and paid parental leave - Defined contribution retirement plans with employer match and other financial wellness programs - Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title Coordinator Pharmacy Benefit Location Cleveland Facility Remote Location Department Clinical Integration-EHP-Pharmacy Job Code C15025 Shift Days Schedule 9:30am-6:00pm Job Summary Job Details Join the Cleveland Clinic team where you will work alongside passionate caregivers and provide patient-first healthcare. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world. The Coordinator – Pharmacy Benefit supports prior authorization processes for EHP, serving as a key resource for members, providers, and pharmacies on prescription coverage and benefit-related inquiries. This role works closely with pharmacists and providers to review and process authorization requests, finalize referrals, and manage communications, including member and provider education. While not involved in dispensing, the coordinator plays a critical role in ensuring timely access to medications, resolving issues, and providing subject matter expertise on pharmacy benefits. The position offers a collaborative environment with opportunities for growth and involvement in new initiatives. This is a remote role in Ohio. A caregiver in this position will work Monday through Friday from 9:30am to 6:00pm with the potential flexible scheduling the future. No holidays, weekends or on-call expectations. A caregiver who excels in this role will: - Respond to physician and member inquires relating to the prescription drug program. - Enter all benefit override requests into an internal database. - Utilize current internal database for pharmacy benefit overrides. - Generate appropriate letters and report and other requests. - Place manual benefit overrides into external vendor's (PBM) computer system. - Comply data and formats this information into the appropriate medium. - Interface with external vendor (PBM) to ensure proper benefit coding and resolve escalated issues. - Ensure proper prescription drug benefit coding and develops solutions to problems that cannot be resolved internally. - Assist the outpatient pharmacy and human resources departments with benefit coverage questions and other copay related issues. - Assist with the implementation and management of pharmacy disease management programs. - Analyze and process other reports to send out mailings or place phone calls to the appropriate members regarding benefit changes. Minimum qualifications for the ideal future caregiver include: - High School Diploma or GED - Knowledge of pharmacy terminology - Certified Pharmacy Technician (CPhT) verified through the Pharmacy Technician Certification Board (PTCB) - Minimum of six months retail pharmacy experience or Pharmacy Technician certification Preferred qualifications for the ideal future caregiver include: - Prior authorization experience Physical Requirements: - Requires frequent computer entry, sitting, standing and walking. - Normal or corrected vision, hearing and speech. Personal Protective Equipment: - Follows standard precautions using personal protective equipment as required. The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances. Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/ Please review the Equal Employment Opportunity poster. Cleveland Clinic is pleased to be an equal employment opportunity employer.