Jobs at Centene Corporation

Analyzes healthcare business processes, claims coding defects, payment integrity issues, and user requirements. Supports data analysis, system testing, implementation planning, process improvement, reporting enhancements, policy updates, and cross-functional problem resolution. Candidates should have business process analysis or healthcare claims experience, knowledge of managed care systems and reimbursement methodologies, and strong Excel skills. This is a remote role requiring U.S. work authorization without visa sponsorship.

Provide high-level administrative support to an executive, handling confidential materials, coordinating meetings and events, preparing correspondence and reports, communicating policies, and managing records and logistics to maximize executive efficiency.

Leads multiple cross-functional projects and enterprise regulatory responses, coordinating Compliance, Legal, Risk, and business stakeholders. Manages project lifecycles, requirements, schedules, resources, budgets, documentation, risks, and communications. Develops operational improvement strategies, ensures regulatory compliance, tracks information requests, validates documents, and presents status updates to stakeholders and executives.

Review complex prior authorization requests to determine medical necessity and appropriate level of care per regulatory guidelines and member benefits. Collaborate with providers, utilization management, and care management teams; escalate to Medical Directors as needed; manage transfers/discharges; maintain clinical records in health systems; provide education, process improvement feedback, and train other team members.

Manage Medicare or Broker Field Sales teams to drive regional enrollment growth. Recruit, onboard, train, engage, and ensure compliance of independent agents. Develop market- and provider-specific sales plans, maintain broker and community relationships, manage incentives and distribution, and collaborate with internal teams to meet sales goals.

Performs concurrent reviews to evaluate members' overall health, medical necessity, level of care, and discharge planning. Documents findings in health management systems, collaborates with providers, medical directors, and care management, provides provider education on utilization processes, and recommends or approves medical determinations per policies.

Analyze contact center workload, forecast volumes, and build staffing and scheduling plans. Monitor performance metrics (service level, ASA, adherence), identify disruptions, prepare reports, and recommend improvements. Maintain schedules, time-off records, and provide feedback to supervisory staff. Support workforce management policies and ad-hoc analyses.

Lead FP&A and G&A finance for a business unit: develop and monitor annual operating plans, forecast and analyze financial performance, manage headcount planning, identify medical cost trends and improvements, support contract financial impact and negotiations, oversee pricing models, reporting strategy, and coordinate with actuaries and senior management.

Lead and oversee the Gold Card Program, driving long-term program development, integration across business units, and ensuring consumer experience, clinical, and engineering expertise inform product design. Manage adaptive technology integration, team-based services for behavior change outcomes, and evaluate financial performance and value propositions for program enhancements and new development.

Lead design, development, implementation, and support of enterprise Identity and Access Management solutions (SailPoint IIQ/IdentityNow). Build/configure connectors, code lifecycle event management, troubleshoot IAM issues, enforce IAM policies, coordinate cross-functional teams, and drive IAM technical strategy, standards, and documentation.

Coordinates statewide clinical appeals, fair hearings, and external reviews. Evaluates clinical information using recognized medical-necessity criteria, prepares case reviews and compliant response letters, maintains appeal files and logs, and collaborates with medical directors to clarify determinations. The role also coordinates fair hearings, follows up with members and providers, and maintains knowledge of NCQA and Oregon regulatory requirements.

Provide clinical data analysis, audits, and workflow recommendations to ensure compliance (HEDIS, URAC, NCQA). Design data pulls, produce analytical and audit reports, support corrective action plans, training, and regulatory audit preparation. Collaborate with clinical teams and data analysts to track performance, forecast staffing, and improve operational processes.

Review psychological testing and treatment documentation for medical necessity and quality; authorize and monitor outpatient behavioral health and substance abuse care; conduct peer reviews; consult with providers and Medical Director; educate network practitioners on best practices and utilization management; respond to complaints and provide clinical oversight for outpatient services.