centene

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

Position Purpose: Identify, manage and oversee the system and business requirements for new and existing business and ensure performance meets all health plan, state, and provider contract requirements. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sp

Position Purpose: Develop, implement and oversee the pharmacy benefit management program across multiple product lines in both centralized and regional environments with multiple locations. Ensure compliance with contractual guidelines of the corporation and health plans impacted by numerous regulat

Position Purpose: Provides executive leadership for risk adjustment performance across markets and lines of business, serving as the key link between Enterprise Risk Adjustment and market leadership to translate strategic priorities into operational execution and measurable results. Leads cross-func

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. Must reside in or near St

Position Purpose: Acts as a liaison with vendors and internal business partners to build strong, continuous relationships and to enable the understanding of business requirements, needs, and service expectation. Works alongside vendor management team members to maintain complex vendor relationships

RN license for state of California required. Position Purpose: Manages the care management team and the care management of members to develop and assess high quality, cost-effective healthcare outcomes. Manages escalations and care management issues related to members or providers. Oversees and revi

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: Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsor

Position Purpose: The Director of Quality Medicare Strategy drives the development of our Multi-year, market specific Medicare Stars Performance Strategy. In addition, this individual plans, and partners with key stakeholders to understand the geographic market expansion of our Medicare business and

Position Purpose: Manage the operations of all credentialing and provider data management functions for multiple business units ensuring compliance with National Committee for Quality Assurance (NCQA), Department of Health and Human Services (DHHS), Center of Medicaid/Medicare Services (CMS) and oth

Position Purpose: Accountable for defining, executing, and continuously advancing Strategic Portfolio Management (SPM) processes to align portfolio initiatives with organizational objectives. Establishes and drives data driven decision making, optimizes process efficiency and establishes robust mech

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: Make outbound calls to new members welcoming them to the Healthplan and providing information and education regarding program features and requirements of the Healthplan. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now

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