Service Care Manager for Behavioral Health at Centene focusing on mental health needs and care coordination. Develops care plans and advocates for members with significant behavioral health issues.
About the role
- Manager overseeing client audits for CVS Health, focusing on Molina audits and coordinating with auditors. Ensuring quality audit processes and identifying enhancement opportunities for risk reduction.
Responsibilities
- Client facing project management position responsible for coordinating, managing and assisting with client audits
- Primarily focus on audits for Molina, with additional support for commercial client audits
- Work closely with various 3rd party auditors and consultants
- Ensure completion of client requested audits with consistency and minimal disruption to the business
- Responsible for the timely and satisfactory resolution of exceptions identified during the audit process
- Identify process enhancement opportunities to reduce or eliminate risk of future client audit exceptions
Requirements
- Minimum five (5) or more years in audit, project management, or pharmacy benefit management (PBM)
- Hands-on experience navigating Rx Claim
- Demonstrated ability with basic Excel and Word functions
- Excellent verbal and written communication skills with ability to communicate technical ideas and results to non-technical clients
- Proven ability to manage multiple projects and deadlines effectively
- Strong problem-solving, analytical, and critical thinking skills
- Bachelor’s Degree OR equivalent work experience required
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings
- Tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
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