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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: 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: 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…
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…
Position Purpose: Provide clinical expertise to clients in designing benefits/clinical programs to optimize therapeutic outcomes while maintaining economic efficiency in the delivery of medication therapy. Interface…
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to…
Liaise between account management and specialty pharmacy to resolve member and payer issues, monitor trends, and ensure high-quality service delivery.
Manages clinical projects to improve healthcare quality, reduce costs, and enhance member experience for a government-affiliated health plan. Focuses on data analysis, workflow optimization, and cross-functional collaboration to drive strategic health outcomes.
Manages multiple concurrent projects and coordinates enterprise regulatory responses for a large healthcare organization, working cross-functionally with compliance, legal, risk, and business teams to ensure timely and accurate regulatory submissions.
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