Submission for the position: Medical Review Coordinator - (Job Number: 1310809)
https://centene.taleo.net/careersection/jobdetail.ftl?job=1310809&lang=en
Medical Review Coordinator
You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpos e: Provides administrative and departmental support for Medical Directors. Provides oversight on MD workflow, clinical reviews and assists in completing activities related to cross functional projects. Essential,Candidate Education: Required A High School or GED
• Reviews MD workflow queue in medical management system and makes adjustments to workflows as needed.
• Manage turn-around-times for authorizations that require review by a Medical Director.
• Provides support for the adverse determination process which includes ensuring notification meets regulatory/contractual requirements for content and timeliness.
• Acts as subject matter expert in regards to required departmental best practices, reports and data extracts.
• Conducts research, including reviewing member records, and organizes documentation to report findings in support of Medical Directors.
• Responds to phones as assigned or team coverage as directed by Medical Directors.
• Serves as a liaison in corresponding and communicating with providers, vendors and WellCare contacts and/or members’ representatives.
• Organizes a variety of administrative and clinical tasks and prioritizes in order of importance and impact on members and providers.
• Manage all communications that are utilized between clinical staff, Medical Director and providers.
• Performs other duties and special projects as assigned.
Our Comprehensive Benefits Package :
• Flexible work solutions including remote options, hybrid work schedules and dress flexibility
• Competitive pay
• Paid Time Off including paid holidays
• Health insurance coverage for you and dependents
• 401(k) and stock purchase plans
• Tuition reimbursement and best-in-class training and development
Education/Experience :  Associate's Degree in a related field preferred.
Required 3 years of experience in a managed care setting, medical office or facility setting with demonstration of medical administration duties
Required 1 year of experience in Directly supporting clinicians
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.
Medical Management
USA-Florida-Tampa
Schedule: Full-time Location(s): USA-Florida-Tampa