Pediatric Public Programs Specialist

Job description

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. Key Details: Applicants for this role will have the flexibility to work remotely from their home anywhere in the State of California. Standard Hours are Monday - Friday 8AM to 5PM PST. Current, valid and unrestricted California Medical Assistant Certification and 3+ years Pediatrics Experience highly preferred. 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. Complies with all policies and standards Education/Experience: Associate’s degree, completion of Vocational Nursing School, Medical Assisting or Pharmacy Technician Program. Minimum three years of combined clinical and healthcare experience. License/Certification: Current, valid and unrestricted California Medical Assistant Certification, or current, valid and unrestricted Licensed Vocational Nurse (LVN) license or current, valid and unrestricted Pharmacy Technician Certification preferred Government Security/Clearance/Citizenship Requirements: Pay Range: $23.23 - $39.61 per hour At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. 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