centene

Position Purpose: Drives the collaboration with business and IT stakeholders to translate complex business requirements into comprehensive functional and non-functional technical specifications, ensuring alignment with strategic goals and solution design. Elicit, analyze, and document business and f

Position Purpose: Develop, implement, and perform compliance auditing, monitoring and reporting activities based on established program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory and contractual requirements. Key Details: Must be authorized t

Position Purpose: Lead the analysis, design, and delivery of business and system requirements for Payment Integrity solutions in the EBP – Finance & Corporate Systems domain, including the PISCES Hub, and vendor integrations with core claims platforms (Amisys, Facets, Xcelys). Serve as the senior su

Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Key Details:Centene is

Position Purpose: Performs receptionist duties and provide administrative support to the executive assistants. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for thi

Position Purpose: Oversees and manages the vendor management function and relevant processes within EBOS Vendor Governance to retain vendor and business partner relationships. Responsible for vendor management activities, including contracting, vendor performance oversight, innovation and ongoing re

Position Purpose: Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive

Position Purpose: Manage all aspects of vendor activity for Utilization Management staff vendors. Key Details: The Manager, Vendor Management position is primarily remote. Candidates will be considered nationwide. Responsibilities: Manage vendor utilization including workflows for coordinating servi

Position summary: This position is responsible for the financial data analytic needs of the organization. The position will use a combination of financial analysis tools and techniques as well as data analysis tools and technologies to generate, analyze, report, and interpret financial and other dat

Position Purpose: Manage day-to-day execution of either the enterprise Privacy & Security Culture training program or the awareness and workforce risk program that strengthen privacy, security, responsible AI, and operational resilience behaviors across Centene. Translate functional strategy into te

Position Purpose: Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care Key Details: Make an impact from home as a Remote Psychologist Revie

Position Purpose: Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company's policies and programs. Provide greater access to health insurance, by providing education and assistan

Position Purpose: Provides functional business knowledge and technical support to the business unit through developed and ad hoc analysis/reporting, as well as designing and programming new processes/reports. Acts as subject matter expert for department or business unit on business systems/applicati

Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and

Position Purpose: This position supports the implementation and/or drives the ongoing operational maintenance of assigned product(s) or service area(s) through communication and solid relationship management with internal and external stakeholders, identifying opportunities for integrated process im

Position Purpose: Supports the delivery of cybersecurity solutions by applying portfolio management best practices. Facilitates the intake review and approval of projects/programs, prioritization of projects, project alignment with overall technical or business strategy, resource forecasting and all

Position Purpose: Act as an advocate for members and a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Establish a community presence, promote member education, identify and resolve any systemic barriers that limit access to appropriate care. Key Details: M

Position Purpose: Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/careg

Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through hom

Position Purpose: Works with care management team on community resource connection activities including connecting members to community resources to support their care management journey and provide necessary care resources in a cost-effective manner. Provides members with known community resources