Experience Inc. Jobs

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.

Candidate must reside in the state of Florida and meet all minimum requirements for the role.

Position Purpose: Manage Specialty Therapy and Rehabilitation Services (STRS) clinical services including management and marketing of clinical services

• Manage clinical services including oversight of clinical policies and procedures and day-to-day operation

• Oversee the provider outreach and training activities pre and post implementation

• Ensure compliance with established initial and concurrent review, referral, and authorization policies, procedures and processes

• Ensure all programs and clinical operations are in full compliance with state and federal regulations, including HIPAA

• Ensure payer contract clinical deliverables are met

• Monitor the effectiveness of existing procedures and outreach/intervention efforts and ensure full compliance with physical, occupational, speech, and home health scope of practice state guidelines

• Analyze data, monitor trends and recommend potential quality improvement opportunities including provider issues, service gaps, member needs

• Ensure accurate and timely reporting to health plan partners on authorizations, denials, appeals, provider outreach, call center metrics, and utilization trends to include analytics and interventions

• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Master’s degree in Speech, Occupational or Physical Therapy or equivalent. 5+ years of specialty therapy or rehabilitation services experience. Thorough knowledge of a specialized or technical field such as case and/or utilization management, including review procedures and educational services. Supervisory experience is preferred.

License/Certification: Current certification/licensure in Speech-Language Pathology, Occupational Therapy, or Physical Therapy in state of practice.

Pay Range: $84,300.00 - $151,700.00 per year

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. Total compensation may also include additional forms of incentives.

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