centene

Position Purpose: Lead and support the design, development and execution of value-based purchasing (VBP) & payment innovation programs across Centene. This role will directly support the achievement of goals and metrics related to payment innovation. Key Details: Must be authorized to work in the U.

Position Purpose: With the Corporate IT Finance Team, you will compile and analyze financial information for the company. Partner closely with business and finance leadership to deliver insightful analysis, develop measures to track, trend and forecast related impacts of organizational strategic ini

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: Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company's policies and programs. Provide greater access to health insurance, by providing education and assistan

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 be authorized to

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: 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: Provides functional business knowledge and technical support to the business unit through developed and ad hoc analysis/reporting , as well as designing and programming new processes/reports. Develops and maintains Power BI dashboards used by our organization. Acts as subject matte

Position Purpose: Works with care management team on administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance w

Position Purpose: Tracks and manages the IT (Information Technology) asset life cycle from selection and depreciation to retirement and replacement. Assists in identifying, controlling, recording, reporting, auditing, and verifying configuration items and asset records, including versions, baselines

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: Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers. Per

Position Purpose: The Payment Integrity Systems Specialist II performs moderately complex Payment Integrity systems, data, reporting, and workflow analysis. The role supports platform enhancements, defect remediation, reporting routines, UAT/release readiness, financial and operational data validati

Position Purpose: The Lead Payment Integrity Systems Specialist is the senior individual contributor and enterprise-level subject-matter expert for Payment Integrity systems, platform governance, analytics, financial reporting, and operational visibility. The role sets technical and operating standa

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

This position has a field component and requires the individual to live in TX. 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 w

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: Must reside in the state

Position Purpose: Support the product teams focus on offering quality, competitive product solutions for growth and retention of our Ambetter marketplace members. Support the annual Product Development Life Cycle for the Commercial Marketplace (Ambetter) products in all states, working as part of a

Position Purpose: The main focus of the role is to support the cash related accounting processes for Medicaid Health Plans along with maintaining accurate financial records, prepare monthly financial statements and participate in special projects. Key Details: Applicants for this role have the flexi

Conduct inpatient concurrent reviews to assess medical necessity using InterQual criteria, corporate and state policies, and available review tools. Support New Hampshire Medicaid through the East Region Shared Services team. Work from 8:00 a.m. to 5:00 p.m. Eastern Time, with required weekend and h