centene

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:Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care p

Position Purpose: Leads the integrity and governance of Centene's and/or its vendors corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance practices. Key Details: Applicants for this job have the flexibility to work remote from home anywhere in the Cont

Position Purpose:Responsible for connecting with plan providers regarding quality initiatives and key quality performance indicators. Shares HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers. Use existing resources to collaborate with provider offices and i

Position Purpose: The Program Manager IV is responsible for all aspects of the planning and delivery of strategic programs and complex, large-scale enterprise-wide projects to execute defined requirements and meet company strategic objectives. This role provides leadership, direction, and hands-on s

Position Purpose: Oversee all compliance functions for the health plan including communication and coordination of policy development. Oversee the accurate and timely submission of over contract deliverables for all lines of business and service delivery areas. Key Details: Applicants for this role

Position Purpose: Provide sales coverage and develop best possible market penetration for all lines of business to present to prospective members in assigned territory in accordance with company's policies and programs. Provide greater access to health insurance, by providing education, assistance a

Position Purpose: Analyzes the contact center's workload to build resourcing and optimize scheduling plans to meet business objectives and goals. Analyzes some complex scheduling information and develops staffing recommendations. Key Details: Must be authorized to work in the U.S. without the need f

Position Purpose: Promote increased program efficiency, service levels, and value by capturing and monitoring performance, and then identifying opportunities for improvement and strategies to realize those opportunities. Plan, organize, monitor, oversee and lead multiple, concurrent resultant projec

Position Purpose: Plan, organize, monitor, and oversee complex projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives. Key Details: Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States

Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Key Details: Applicants for this r

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 is a fully remote position with a Monday throug

Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and thei

Position Purpose: With the Corporate Operations team, you will manage third party program relationships with Delegation partners for performance management standards, financial responsibility, and proactively implements appropriate business solutions as required. Duties will include: Vendor Relation

Position Purpose: With the Corporate Operations team, you will manage third party program relationships with Delegation partners for performance management standards, financial responsibility, and proactively implements appropriate business solutions as required. Duties will include Vendor Relations

Position Purpose: Serves as a vital link between members and the healthcare system, focusing on improving health outcomes by identifying and closing care gaps. This role emphasizes community engagement, member education, and collaboration with providers and internal teams to ensure members receive t

Position Purpose: Claims Auditor is responsible for the quality audit of a variety of specific processes within the operations services for Claims to ensure quality service goals and standards are met and/or identify areas where improvement can be achieved. Provides audit feedback regarding the exce

Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and thei

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. Key Details: Remote role. Candidates must possess a valid, active, and unrestr

Position Purpose: Provides resource support to members and connects members to local resources for various services (e.g., employment, housing, independent living, justice, foster care) based on care/service assessment and plans. Works with leadership to identify the best, most appropriate local res