Maintain Medical Management operational policies, procedures and workflows to ensure compliance with the state, CMS and accrediting body regulations and standards.
LPN with 5+ years of utilization or case management experience or RN with 4+ years of utilization or case management experience. Strong written and verbal communication skills. Experience writing and maintaining policies and procedures preferred.
License/Certificates: Current state’s active LPN or RN license
• Review and make necessary updates to medical management policies, procedures and work processes to maintain compliance with various agencies and regulations, including CMS and NCQA requirements
• Develop new policies and procedures for the medical management function to meet business needs
• Assist with the creation of readiness documents and various medical management policies for new health plans
• Assist the Compliance department with completions of URA certification applications and renewals
• Serve as a subject matter expert on business practices, policy changes, and various medical management guidelines to assist in defining business needs into system alternatives
Centene Corporation - 2 years ago
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...