centene

Position Purpose: Uses advanced expertise and knowledge to lead the development and operationalization of data pipelines to make data available for consumption (reports and advanced analytics), including data ingestion, data transformation, data validation / quality, data pipeline optimization, and

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: This position support

Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Key Details: This is a fully remote ro

Position Purpose: Direct and oversee regulatory compliance operations to ensure fully compliance with all applicable laws and regulations for assigned products/services. Key Details: The role is fully remote. Must be authorized to work in the U.S. without the need for employment-based visa sponsorsh

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 Ambetter / Marke

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: Oversee the day-to-day work functions of the assigned claims area, provide technical and leadership support to staff to resolve complex issues. The Supervisor will develop and implement policies and procedures that comply with state and federal regulations. Process improvement, cos

Position Purpose: Supports community connection activities including connecting members to community resources to support their care management journey and provide necessary care resources in a cost-effective manner. Provides members with known community resources and supports the care team to ident

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 California Marke

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 Behavioral Health position wi

Position Purpose: Supports the prior authorization request to ensure all authorization requests are addressed properly and in the contractual timeline. Aids utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members

Position Purpose: Assist in the planning, implementation and evaluation of the state-wide marketing & communication program while promoting a favorable public image of the company and each of its product lines. Key Details: Must be authorized to work in the U.S. without the need for employment-based

Position Purpose:Responsible for analytical data needs. Handle complex data requests, reports, and predictive data modeling. 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 ava

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: Must reside in the st

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate

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: 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

By applying to this requisition, you acknowledge and understand that you may be considered for other job opportunities for which Centene believes you may be qualified. We're hiring Actuarial Analysts - Remote These opportunities are designed for individuals committed to the actuarial career path, wi

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: Must reside in Georgi

****NOTE: This is a work-from-home, remote role with occasional travel (up to 10%) to our various Ohio offices for essential business meetings. This position supports Long Term Care (LTC) Care Coordination through activities such as member outreach and mailings, appointment scheduling and reminders,