Public Programs Specialist

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: The Public Programs Coordinator is responsible for triaging and resolving member access to care issues and coordinating services with programs that are “carved out” of the health plan contract with the Department of Health Care Services, i.e. California Children’s Services and Regional Centers, as well as, promoting member access to Health Net’s Empower Living Program (H.E.L.P.) This position is also responsible for communicating and collaborating with internal and external customers to ensure access to care and services for Health Net members.

• Researches, resolves, makes referrals and follows up with clients and agencies for access to care issues.
• Collaborates with multiple Health Net Departments including, but not limited to, Member Services, Provider Network Management, Medical Management, Medical Review Unit, Pharmacy and Claims to resolve member issues.
• Serves as Health Net’s liaison to public agency programs and assists with referrals from the Participating Physician Groups (PPG) to the H.E.L.P Program.
• Receives, researches and resolves coordination of care referrals from Customer Services.
• Conducts escalated service coordination on complex cases and monitors through resolution.
• Supports programs such as Regional Centers, School Health Integration and California Children’s Services with in-person meetings to better understand and promote available services.
• Researches and prepares conflict resolution documentation to support Appeals and Grievances.
• Prepares and submits monthly and quarterly COC reports to compliance.
• Performs other duties as assigned.

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