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. **_***Fully remote role, candidate may reside in any state within the Continental US. Candidate must be willing to work CST work hours.***_** **Position Purpose:** Support utilization management activities to facilitate medical necessity review and other related services associated with the Centralized Transplant Unit (CTU) prior authorization process. Serves as a point of contact to members, providers, and staff to resolve issues and documents within the member record in accordance with current regulatory requirements. + Serves as an advocate for patients, ensuring they receive timely access to transplant medically necessity review and determination processes. + May apply working knowledge of Transplant Unit activities and resources. + Serves as the front-line support and on various clinical and non-clinical, member and/or provider inquiries, other internal/external customer requests, or concerns which may include explaining transplant specific utilization management policies and procedures and claims payment processes. + Works to ensure member and provider eligibility and benefits for transplant procedures, including pre-authorization and claims processing. + Provides education and support to providers regarding submission of proper documentation for processing transplant service requests. + Maintains accurate and up-to-date member and provider documentation within the appropriate clinical documentation system. Maintains private health information (PHI) cy of member records to ensure standards of practice and policies. + Collaborates with other departments on cross functional tasks (i.e., claims processing). + Performs other duties as assigned + Complies with all policies and standards **Education/Experience:** High School Diploma or equivalet required 1+ years Related Experience required Less than 1 year Knowledge of medical terminology preferredPay Range: $22.79 - $38.84 per hour 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