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American multinational healthcare company
Position Purpose: Plan and drive execution of Medical Management utilization programs, processes, and initiatives to ensure achievement of health benefit ratio targets, and appropriate reductions in utilization related…
Position Purpose: Directs the utilization management team to ensure the appropriate application of policy procedures and processes to help support best member outcomes. Oversees and manages Utilization Operations…
Position Purpose: Responsible for driving the product performance function for assigned products, across multiple lines of business. Oversee the review of product performance, the analysis of performance of products,…
Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes. Key Details: Candidate must reside within the…
Position Purpose: Responsible for leading the integration, modernization, and efficient operation of Centene's enterprise telephony and contact center platforms. Involves close collaboration with business process…
Position Purpose: Provides strategic and operational leadership for enterprise interoperability capabilities across the enterprise. Responsible for enabling healthcare data to move securely and seamlessly between…
This is a remote position and can be located anywhere in the US. Position Purpose: Develop innovative procurement solutions at a project/category/organizational level and provide guidance to category team for sourcing…
Position Purpose: This role is responsible for leading the end-to-end implementation of technology solutions supporting Care Management, translating business and clinical requirements into scalable, well-governed…
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…
Analyzes and develops product solutions to improve performance and reduce risk for healthcare product lines, applying project management and change management disciplines.
Position Purpose: Designs, builds, and deploys AI-powered tools and automated workflows that enable the Finance organization to work more efficiently and make better decisions. Applies modern data engineering and AI…
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…
Position Purpose: Ensure regulatory compliance with state and other government agencies related to Health Net, Centene Corporation, and its business subsidiaries. Key Details: Applicants for this role must live in the…
Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical…
Position Purpose: Leads the strategy, development, and execution of product, customer experience, digital and operational capabilities for the ICHRA business. Responsible for translating customer and market insights…
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…
Position Purpose: The position is responsible for providing leadership and direction for clinical, quality, and risk adjustment functions. Execute on the development and oversight of clinical programs for physician…
Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function. Key Details: Prefer candidates who possess a claims coding background with payment integrity…
Oversees healthcare quality improvement projects, ensuring compliance with NCQA/HEDIS standards, and coordinates data-driven initiatives to enhance care delivery and regulatory adherence.
Position Purpose: Direct the process for identifying and obtaining the appropriate licenses for new and existing businesses. Assist new business development and expansion for companywide operations Identify state…
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