centene

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 fully remote role supports the Kentucky Market

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: 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. Per

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: Perform provider data management related activities based on plan and contract specifications and standard business rules – includes data analysis and entry, review of data via internet sites and other systems, and usage of multiple systems and applications to validate data is comp

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. Position Purpose: Analyze

Position Purpose: Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care giv

Position Purpose: The Clinical Pharmacist processes review prior authorization requests for non-formulary medications for clinical appropriateness. This assures members receive the most effective and cost effective pharmacological therapies. Key Details: Must be authorized to work in the U.S. withou

Position Purpose: Provide strategic and operational insights to senior leadership to drive the key initiatives and growth plans in the market. Collaborate with Corporate Strategy partners to ensure alignment with broader organizational Initiatives. Act as a key resource for information gathering and

Position Purpose: The Senior Manager of Credentialing and PDM will oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa spons

Position Purpose: Responsible for supporting accounting operations through financial reporting, reconciliations, account analysis, and month-end close activities while ensuring accuracy, compliance, and timely completion of accounting processes. Key Details: Candidates must have a Bachelor’s degree

Position Purpose: Enables the strategy and execution of communications and change outcomes as it relates to the successful execution of strategic initiatives in the transformation portfolio. Ensures leadership behaviors and culture are linked to all aspects of transformational change. Key Details: M

Position Purpose:Lead the development, coordination, and execution of operational strategies and process improvements across shared services to support enterprise and market‑level product growth, implementation, and performance objectives. Translates strategy into operating plans, facilitates cross‑

Position Purpose: Lead external relations activities in Kansas in accordance with Centene, health plan, government, and contractual guidelines. Develop and maintain relationships with legislators, county governments, associations, and other key stakeholders to monitor, influence, and advance healthc

****Position requires candidate to live within the state of Michigan**** Position Purpose: The Director of Government Affairs is responsible for coordinating state government relations and legislation for the Department of State Government Relations and assists the Department of Legislative and Regu

Position Purpose:Provide communications and content marketing expertise to support internal and external communications, content strategy, and stakeholder engagement initiatives. Manage the editorial cycle from content creation through delivery for written communications, marketing materials, and ca

Position Purpose: Develop and produce marketing materials and coordinate website changes. Provide support to implement the strategic public relations and communication plan for the organization. Work closely with Senior Management to implement strategic communications plan and marketing initiatives

Position Purpose: Audit medical records to identify inappropriate billing practices and recommend next steps through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards. Key Details: Preferred qualifications include coding certification, n

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: Conduct strategic analysis, peer review, build and support tools to aid in planning processes, pricing, and assess risk to estimate financial outcomes. Provide expertise and technical support in matters related to the successful and financially sound operations of the company's bus