Centene Corporation
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose Maintain collaborative relationships with Health & Family Services, government agencies, community resource and advocacy groups, to build additional community support for current and potential enrollees.
Work effectively with internal staff, staff at local and state government agencies, and with contracted health plans and regulatory/accreditation entities to develop and implement processes to better serve enrollees
Establish and maintain key community relationships throughout State
Develop and implement appropriate policy and procedure to ensure health plan staff are able to facilitate enrollee and provider needs through entire case management cycle
Communicate, identify, resolve, and prevent care problems, with other systems of care, as well as government and community agencies.
Monitor and report on achievement of committed action plans
Facilitate on-going communication between the health plan, provider community, and Health & Family Services
Coordinate outreach activities to identify enrollees needing care within the urban and rural populations
Compile and review reports on work function activities for statistical, financial and process improvement tracking purposes to identify trends, assist in financial forecasting, and make recommendations to management
Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives
Ensure compliance with State law and regulations
Additional responsibilities for LHCC (LA) only for DOJ positions:
Will serve as the LHCC representative for this program with the state
Participate in MCO workgroup meetings to review and make appropriate changes to the LDH-approved guidance documents for this program to include but not limited to: agency standard operating procedure, training guidelines, assessment tools, care plan templates, and follow-up progress notes.
Serve as the point of contact for our delegated PASRR vendor
Contribute to monthly reporting for PASRR submitted to LDH
Perform quality checks on PASRR documentation submitted by vendor before sending to LDH
Ensure timelines for PASRR completion are adhered to
Collaborate w/ LDH/OBH PASRR liaison
Attend state transition coordination meetings as needed
Other duties as assigned
Additional responsibilities for Trillium Community Health Plan / Oregon Market
Serve as point of contact for communicating with members, the community, Traditional Health Worker (THW) Workforce, stakeholders, and internal department regarding THW services.
Implement and maintain THW integration and Utilization Plan in collaboration with key stakeholders.
Create and lead THW Workforce Advisory Committee at Trillium level to advise their work activities and create two-way communication, bi-directional learning, and collaboration with the THW workforce in their service area.
Outreach to current and future employers of THWs and work with them to improve THW recruitment and retention. Assisting supervisors and managers with understanding the THW care model, scope of work, and their oversight responsibilities as well as ensuring THWs Providers are integrated into a member’s care team and the THW services an integral component of a member’s health care Treatment Plan.
Integrate THWs into the delivery of services.
Assess barriers to integration and utilization of THWs and their services.
Facilitate/promote education to health on understanding the THW core roles, and skills, and their oversight responsibilities as well as ensuring THWs Providers are integrated into a member’s care team and the THW services an integral component of a member’s health care Treatment Plan.
Assist members with utilizing THW services across all settings.
Provide technical assistance to THWs regarding certification, recertification, and assisting with THW enrollment and billing.
Support development and promote adoption of sustainable, THW-specific Medicaid reimbursement processes for THWs that can be used across a variety of settings (clinc, hospital, community-based organizations, schools etc.).
Partner with THW worker type-specific professional associations and other THW Liaisons from other Coordinated Care Organizations (CCOs) statewide and community partners to build shared annual work plans, deploy trainings and facilitate community coordination that is responsive to stakeholder needs. Maximize opportunities for collaboration, shared learning.
Create detailed reports of project progress as required by CCO contract regulations. Ensure timely submission of all THW deliverables to the Oregon Healthcare Authority (OHA).
Develop and work closely with marketing on THW communications and materials to members, providers, and community-based organizations.
Performs other duties as assigned
Complies with all policies and standards
Candidate must live in NC Highly Preferred Skills & Experience
Proven success in partner-facing roles
Strong community engagement
Community advocacy
Strong communication skills
Deep understanding of social issues
Bilingual Spanish, French, Creole a plus
50% Travel and 50% Remote supporting Region 6 (26 counties)
Candidate must live in NC, Region 6
Education/Experience Bachelor’s degree in Social Work, Nursing, or related field. 5+ years of social services or advocacy experience preferably in Medicaid environment.
License/Certification LCSW or RN license preferred.
Pay Range: $55,100.00 - $99,000.00 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, 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
#J-18808-Ljbffr
Position Purpose Maintain collaborative relationships with Health & Family Services, government agencies, community resource and advocacy groups, to build additional community support for current and potential enrollees.
Work effectively with internal staff, staff at local and state government agencies, and with contracted health plans and regulatory/accreditation entities to develop and implement processes to better serve enrollees
Establish and maintain key community relationships throughout State
Develop and implement appropriate policy and procedure to ensure health plan staff are able to facilitate enrollee and provider needs through entire case management cycle
Communicate, identify, resolve, and prevent care problems, with other systems of care, as well as government and community agencies.
Monitor and report on achievement of committed action plans
Facilitate on-going communication between the health plan, provider community, and Health & Family Services
Coordinate outreach activities to identify enrollees needing care within the urban and rural populations
Compile and review reports on work function activities for statistical, financial and process improvement tracking purposes to identify trends, assist in financial forecasting, and make recommendations to management
Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives
Ensure compliance with State law and regulations
Additional responsibilities for LHCC (LA) only for DOJ positions:
Will serve as the LHCC representative for this program with the state
Participate in MCO workgroup meetings to review and make appropriate changes to the LDH-approved guidance documents for this program to include but not limited to: agency standard operating procedure, training guidelines, assessment tools, care plan templates, and follow-up progress notes.
Serve as the point of contact for our delegated PASRR vendor
Contribute to monthly reporting for PASRR submitted to LDH
Perform quality checks on PASRR documentation submitted by vendor before sending to LDH
Ensure timelines for PASRR completion are adhered to
Collaborate w/ LDH/OBH PASRR liaison
Attend state transition coordination meetings as needed
Other duties as assigned
Additional responsibilities for Trillium Community Health Plan / Oregon Market
Serve as point of contact for communicating with members, the community, Traditional Health Worker (THW) Workforce, stakeholders, and internal department regarding THW services.
Implement and maintain THW integration and Utilization Plan in collaboration with key stakeholders.
Create and lead THW Workforce Advisory Committee at Trillium level to advise their work activities and create two-way communication, bi-directional learning, and collaboration with the THW workforce in their service area.
Outreach to current and future employers of THWs and work with them to improve THW recruitment and retention. Assisting supervisors and managers with understanding the THW care model, scope of work, and their oversight responsibilities as well as ensuring THWs Providers are integrated into a member’s care team and the THW services an integral component of a member’s health care Treatment Plan.
Integrate THWs into the delivery of services.
Assess barriers to integration and utilization of THWs and their services.
Facilitate/promote education to health on understanding the THW core roles, and skills, and their oversight responsibilities as well as ensuring THWs Providers are integrated into a member’s care team and the THW services an integral component of a member’s health care Treatment Plan.
Assist members with utilizing THW services across all settings.
Provide technical assistance to THWs regarding certification, recertification, and assisting with THW enrollment and billing.
Support development and promote adoption of sustainable, THW-specific Medicaid reimbursement processes for THWs that can be used across a variety of settings (clinc, hospital, community-based organizations, schools etc.).
Partner with THW worker type-specific professional associations and other THW Liaisons from other Coordinated Care Organizations (CCOs) statewide and community partners to build shared annual work plans, deploy trainings and facilitate community coordination that is responsive to stakeholder needs. Maximize opportunities for collaboration, shared learning.
Create detailed reports of project progress as required by CCO contract regulations. Ensure timely submission of all THW deliverables to the Oregon Healthcare Authority (OHA).
Develop and work closely with marketing on THW communications and materials to members, providers, and community-based organizations.
Performs other duties as assigned
Complies with all policies and standards
Candidate must live in NC Highly Preferred Skills & Experience
Proven success in partner-facing roles
Strong community engagement
Community advocacy
Strong communication skills
Deep understanding of social issues
Bilingual Spanish, French, Creole a plus
50% Travel and 50% Remote supporting Region 6 (26 counties)
Candidate must live in NC, Region 6
Education/Experience Bachelor’s degree in Social Work, Nursing, or related field. 5+ years of social services or advocacy experience preferably in Medicaid environment.
License/Certification LCSW or RN license preferred.
Pay Range: $55,100.00 - $99,000.00 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, 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
#J-18808-Ljbffr