centene

Position Purpose: Manage the day to day operations of the Sales and Marketing department. Key Details: Candidate must reside in the state of NY. Field marketing, relationship building, and enrollment covering Monroe County, Rochester, Finger Lakes, Western NY Regions. Manage and maintain assigned ac

Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to ment

Position Purpose:Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Perf

Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Key Details: This role supports our Texas Ambetter Inpatient Beha

Position Purpose: Conduct analysis, pricing, and risk assessment to evaluate and project Medicare Advantage financial performance. As part of the Medicare Actuarial Forecast & Financial Performance Team, this role supports quarterly forecasting, Medicare bid target setting, and key business decision

Position Purpose: The Community Relations Specialist is responsible for leading activities to achieve membership/enrollment goals through various means including, but not limited to, marketing projects and new market initiatives, health fairs and community activities, training, member retention acti

Position Purpose: Responsible for the operation, maintenance, and continuous improvement of enterprise data security technologies that protect and govern sensitive data. This role independently resolves technical issues, implements new capabilities, and drives operational improvements that strengthe

Position Purpose:Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Perf

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: Performs care management duties to assess, plan and coordinate aspects of medical and supporting services across the continuum of care for post-discharge members, promoting quality and cost effective care. Completes medication review for pre-admission and post-discharge reconciliat

Position Purpose: The Health Benefit Representative (HBR) is responsible for educating and assisting individuals with enrolling in affordable health insurance coverage through the NY State of Health Marketplace. This includes Medicaid (NYM), Child Health Plus (CHP), Essential Plan (EP), Qualified He

Position Purpose:The Health Benefit Representative (HBR) is responsible for educating and assisting individuals with enrolling in affordable health insurance coverage through the NY State of Health Marketplace. This includes Medicaid (NYM), Child Health Plus (CHP), Essential Plan (EP), Qualified Hea

This is a remote position that can be located anywhere. Position Purpose: Oversee the maintenance of accurate financial records and financial analytic functions. 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: The HR Program Manager III is responsible for leading and executing business-critical talent initiatives that support organizational priorities and workforce transformation. This role oversees the design, implementation, and continuous improvement of leadership development programs

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 fo

Position Purpose:Responsible for independently conducting comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure the accuracy of DRG assignment and reimbursement. Requires advanced expertise in ICD-10-CM/PCS coding and the ability to exercise discretion and professio

Position Purpose: Oversee the product development function, including formulating product vision and strategy, defining future product needs and enhancements, and driving the creation of profitable, highly engaging, easy-to-use products across all business units. Develop and oversee the model for ma

Position Purpose:Lead the development and execution of business development strategies that expand the company's market presence and drive growth of Individual Coverage Health Reimbursement Arrangements (ICHRAs). Build and strengthen relationships with brokers, employers, and key stakeholders; ident

Position Purpose: Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, medical records, provider information, and other relevant evidence to identify potential misconduct and support case resolution. Document investigative activities, prepare reports and referral

Position Purpose: Develop written responses to complex, high-scoring Medicaid Request for Proposal (RFP) section supporting the company's growth and expansion goals. Key Details: Occasional evening and weekend work may be required during peak RFP and re-procurement periods. Clinical healthcare exper