centene

Position Purpose: Oversee operations, and business strategy utilizing cross-functional departments to meet strategic objectives. 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

Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education f

Position Purpose: Observe preceptors and participate in various projects to learn and develop skills related to the Managed Care industry. Develop clinical knowledge and skills by learning about various processes and functions within the Managed Care industry Observe processes and shadow preceptors

Centene's Sunshine State Health Plan is looking for a Florida licensed RN to support our Medicaid/Medicare MMA membership. Applicants must reside in the state of Florida, and be able to work a Monday - Friday 8am - 5pm schedule eastern time zone. Ideal applicants will have clinical experience workin

Position Purpose: Manage the business processes related to risk adjustment and quality improvement across Centene’s for assigned products and plans. 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

Position Purpose: Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. Learn various job functions within the Managed Care industry and explore various career opportunities Apply academic knowle

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: Utilizes business expertise to facilitate, lead and drive complex large scale work efforts across domains and/or large scale cross functional initiatives with matrixed team support. Analyzes and measures the effectiveness of existing business processes and develop sustainable, scal

Position Purpose: Provides advanced business and technical expertise to design, build, validate, implement, and support complex data solutions, reporting, applications, and automations. Serves as a subject matter expert in business systems, claims data, audit sampling, databases, and reporting platf

Position Purpose: Manage all activities related to the intake, referral management and insurance verification functions, including implementation of initiatives. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorsh

Position Purpose: Provides comprehensive support to Fidelis and Wellcare members by addressing inquiries, conducting outreach, and assisting with enrollment in various health plans, including Medicaid, Medicare, and other Fidelis Care products. This role requires in-depth product knowledge, consulta

Position Purpose: Maximizes member retention across the Enterprise by managing a team of retention performance managers that identifies, researches, prioritizes and determines the appropriate course of action for all applicable business matters. Directs monitors and contributes to special projects a

Position Purpose: Enters, uploads, and posts daily cash receipts and transmits EFT files to banks. Establishes member bank account information for account drafts, sets up new member EFTs, and balances daily receipts with system postings. Performs daily cash receipt reconciliations against Treasury c

Position Purpose: Enters, uploads, and posts daily cash receipts and transmits EFT files to banks. Establishes member bank account information for account drafts, sets up new member EFTs, and balances daily receipts with system postings. Performs daily cash receipt reconciliations against Treasury c

Position Purpose: The Senior HEDIS Quality & Audit Analyst serves as an enterprise subject matter expert responsible for advanced HEDIS quality oversight, audit readiness, and submission support activities. This role independently interprets regulatory and audit requirements, leads complex HEDIS aud

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 this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT **Candidates must reside i

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: Design, implement and monitor IT controls for core applications and systems. Analyze IT data to assess risk and improve processes and efficiency. Key Details: Conduct various Risk Assessments of information technology systems and internal processes. Recommend controls to mitigate l

Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. Monitors and tracks UM resources to ensure adherence to performance, complianc

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