Centene Corporation

Manager

• Prepare and maintain monthly estimates of inpatient incurred but not reported (IP IBNR) expenses
• Collaborate with the Utilization Management team to review inpatient authorization data and establish a recurring validation process
• Develop and maintain standardized review processes and reporting for inpatient spend
• Analyze key drivers contributing to budget and forecast variances
• Oversee preparation of accurate and timely financial reports for IP spend
• Oversee financial and business analyses based on information from various sources and financial reports
• Interpret financial reports for management team
• Review and evaluate analyses and recommend appropriate actions to senior management
• Prepare budgets and forecasts and analyze financial results related to IP claims and authorization
• Monitor legislative and political developments affecting the business unit from a financial perspective

Senior Manager, IP Validation

Financial Planning and Analysis

• Compile and analyze financial information for the company
• Lead various financial projects
• Maintain and manage a working forecast incorporating updated assumptions and business inputs
• Own and execute quarterly forecast loads, ensuring accuracy, completeness, and timeliness
• Support assumption-based budget development, including scenario modeling and sensitivity analysis
• Communicate budget and forecast assumptions, changes, and impacts to finance leadership and business partners
• Perform month-end close activities, including accruals, reconciliations, and supporting schedules related to hardware, software, and telecom spend
• Prepare and communicate monthly financial results to SVP-level partners, including insights, trends, and variance drivers versus forecast and budget
• Analyze data, identify drivers of financial outcomes, and proactively advise partners
• Deliver portfolio-level reporting and analysis focused on performance, risks, and opportunities
• Prepare monthly and weekly data files for reporting, forecasting, and ad hoc analysis
• Lead process improvement and automation efforts
• Perform demand and capacity analysis to assess financial and operational trade-offs
• Maintain detailed non-labor financial data and key metrics
• Provide insight-driven analysis supporting financial targets and strategic objectives
• Identify risks and opportunities early and recommend actionable solutions
• Facilitate financial support for renewals of existing technology in compliance with financial and procurement policies
• Review and support technology purchase approvals, validating financial impact and budget alignment

Finance Analyst III – IT Finance

• Develop, assess, and facilitate complex care management activities for primarily mental and behavioral health needs
• Evaluate member needs via phone or in-home visits and recommend or facilitate care/service plans
• Conduct telephonic, digital, home, and other site-visit outreach
• Develop ongoing care plans for high-acuity members and identify providers, specialists, and community resources
• Coordinate among members, families/caregivers, community resources, and care provider teams
• Monitor care plans, member status, treatment side effects, complications, and clinical symptoms
• Facilitate care coordination and collaborate with providers and specialists to ensure timely access to care
• Collect, document, and maintain member information and care management activities for regulatory compliance
• Educate members and families on procedures, provider instructions, treatment options, referrals, and healthcare benefits
• Provide leadership feedback on opportunities to improve care quality and cost-effectiveness
• Comply with all policies and standards and perform other duties as assigned

Care Manager, Behavioral Health

• Assess and coordinate medical and supporting services across the continuum of care for complex/high-acuity pediatric populations
• Develop, monitor, and update personalized long-term care and service plans
• Evaluate member needs and recommend plans for optimal outcomes
• Collaborate with care management teams, healthcare providers, specialists, facilities, agencies, and community resources
• Coordinate person-centered care between members/families or caregivers and provider teams
• Monitor member status, complications, clinical symptoms, progress, and changes in condition
• Review referrals, intake assessments, and member data to develop care plans and improve quality and operating performance
• Collect, document, and maintain member and care management information for regulatory and clinical compliance
• Educate members and families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, benefits, and community resources
• Act as liaison and member advocate between members/families, physicians, facilities, and agencies
• Coordinate service authorizations for services such as meals, employment, housing, foster care, transportation, and activities of daily living
• Perform home and other site visits, including visits once a month or more as required
• Partner with leadership to improve quality, service delivery, and cost effectiveness
• May precept, coach, and support clinical new hires and preceptees during onboarding
• Perform other assigned duties and comply with policies and standards

Senior LTSS Service Care Manager, RN – Pediatrics

Business Operations

• Identify, manage and oversee system and business requirements for new and existing business
• Ensure performance meets health plan, state and provider contract requirements
• Oversee system builds for new markets and products, including configuration and testing
• Monitor and evaluate system performance trends and identify improvement opportunities
• Oversee the timeliness and accuracy of reporting deliverables
• Establish and manage business specifications for authorization and claims/encounters system infrastructure
• Identify and implement process improvements across new business implementations, claims, encounters, auto adjudication, benefit specification testing and system integrity
• Establish and manage special projects to improve organizational efficiency, productivity and accuracy
• Oversee design and maintenance of market provider contract rate exhibits and configuration/testing of negotiated contracts

Senior Manager, Business & Systems Operations

Business Analyst

• Perform analysis and interpretation to link business needs and objectives for the assigned function
• Support business initiatives through data analysis, identify implementation barriers, and conduct user acceptance testing
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Perform detailed analysis on multiple projects, recommend business solutions, and ensure successful implementations
• Enhance performance management and operational reports related to new business implementation processes
• Coordinate with business units and departments to develop and deliver training programs
• Develop, share, and incorporate organizational best practices into business applications
• Diagnose problems and identify opportunities for process redesign and improvement
• Formulate and update departmental policies and procedures
• Serve as subject matter expert on the assigned function product to ensure operational performance
• Perform other duties as assigned

Business Analyst III, Quality Data

Bilingual

• Educate and assist individuals with enrolling in affordable health insurance coverage through the NY State of Health Marketplace
• Explain eligibility for public programs, federal premium tax credits, and cost-sharing reductions
• Teach members about Fidelis digital tools, including the member portal and mobile app
• Describe plan features, benefits, deductibles, co-pays, co-insurance, and Marketplace metal tiers
• Assist consumers with submitting required documents via scan, fax, or mail
• Support existing members with renewals and recertifications
• Help consumers with premium payment submissions
• Provide culturally and linguistically appropriate assistance
• Conduct public education activities, presentations, ACA forums, workshops, and community events
• Maintain daily activity tracking and monitor personal dashboards for timely follow-up
• Follow up on enrollment leads and consumer inquiries and record dispositions in the CRM
• Enter applicant demographic, enrollment site, and PCP selection data in the CRM
• Safeguard confidential information and comply with privacy, security, conflict-of-interest, regulatory, and company standards
• Participate in trainings, updates, webinars, and required annual Marketplace Facilitated Enroller recertification
• Keep current with ACA, Marketplace, industry, and regulatory updates
• Perform other assigned duties

Health Benefit Rep, Bilingual Arabic

Data Analyst

• Provide advanced analytical support for business operations across claims, provider data, member data, clinical data, HEDIS, pharmacy, and external reporting
• Extract, load, model, and reconcile large amounts of data across multiple system platforms and sources
• Review data to determine operational impacts and needed actions
• Elevate issues, trends, areas for improvement, and opportunities to management
• Develop reports and deliverables and make recommendations to management
• Model data using MS Excel, Access, SQL, and/or other data warehouse analytical tools
• Assist management in driving business decisions based on data
• Ensure compliance with federal and state deliverable reporting requirements through data quality audits and analysis
• Assist with training and mentoring other Data Analysts
• Assist with determining workload and related activities for other Data Analysts
• Perform other duties as assigned
• Comply with all policies and standards

Data Analyst IV, Provider Data Management

Advocate

• Act as an advocate for Members and liaison between the Health Plan and Providers to ensure availability and access to care
• Establish a community presence and promote Member education
• Identify and resolve systemic barriers limiting Members’ access to appropriate care
• Receive and respond to Member complaints and formal grievances
• Identify potential access barriers and resolve them according to the grievance procedure
• Investigate and resolve access and cultural sensitivity issues identified by Member Services staff, State staff, providers, advocacy organizations and recipients
• Participate in local community organizations to understand Members’ special health care needs
• Update and revise educational materials as appropriate
• Serve as primary contact for Member advocacy groups, human services agencies and State entities
• Maintain confidentiality per HIPAA guidelines

Member Advocate I

Operations

• Provide direct supervision to entry and/or processing staff
• Hire, train, evaluate, develop and manage staff performance
• Monitor and direct workflow for timely and accurate processing
• Develop policies and procedures to improve efficiencies and support new contracts or programs
• Interface with internal staff, field personnel, other contractors and customers
• Create and monitor reports for process control and production effectiveness
• Adjust processes to maintain quality standards and achieve operational goals
• Ensure production effectiveness by monitoring reports, assigning resources, analyzing processes and recommending improvements
• Ensure quality effectiveness through process and procedure adjustments
• Respond to customer inquiries and track issues for process improvement
• Represent the department to promote relationships, improve processes and secure goals
• Collect and analyze operational data to identify call reasons and efficiency improvements
• Perform quality control and provide staff feedback and coaching
• Handle associate issues, disciplinary matters, timekeeping and scheduling
• Handle escalations
• Work on special projects and support corporate and departmental goals
• Analyze and construct procedures for new programs or contracts
• Maintain relationships with other departments to support collaboration and customer satisfaction
• Perform other assigned duties and comply with policies and standards

Operations Supervisor

Sales

• Provide sales coverage and develop market penetration for products in assigned territory
• Provide education and assistance to Medicare individuals
• Distribute health education materials and arrange for health screenings
• Provide Facilitated Enrollment and assist with health insurance continuation and recertification
• Identify prospective enrollees and determine eligibility for Advantage Medicare
• Apply policies and procedures for product disclosures, enrollment and disenrollment
• Develop a local community presence to generate enrollments
• Conduct home visits and personalized appointments to complete enrollment
• Market Advantage at hospitals, senior centers, assisted living facilities, community events and other designated sites
• Explain covered and non-covered benefits, exclusions and exemptions
• Assist members with health care access, transportation and related services
• Follow marketing activity guidelines and provide required materials and documentation
• Monitor competitive products and marketing practices and inform management
• Conduct telemarketing and outreach efforts
• Attend sales meetings, training programs, conventions and special events
• Complete applications accurately and promptly
• Submit territory, product acceptance/rejection and competitive-condition reports
• Perform other assigned duties and comply with company policies and standards

Sales Representative – Medicare

• Perform care management duties to assess, plan, and coordinate medical and supporting services for post-discharge members
• Complete medication reviews and reconcile pre-admission and post-discharge medications
• Identify transition support services with care management and coordination teams
• Complete post-discharge assessments for members transitioning from healthcare facilities
• Develop care/service plans and collaborate with discharge planners, providers, specialists, and interdisciplinary teams
• Assess member health status, resource needs, services, and treatment plans and provide interventions
• Facilitate transition into active care management based on member needs
• Provide education and resource materials to members, caregivers, and providers
• Coordinate services among PCPs, specialists, medical providers, and non-medical resources
• Conduct telephonic, digital, home, and/or site outreach
• Document member information and care management activities for regulatory compliance
• Provide leadership feedback on opportunities to improve cost-effective care and quality delivery
• Perform other assigned duties and comply with policies and standards

Care Manager, Transition of Care – RN

Care Coordinator

• Evaluate member needs and available resources and recommend or facilitate plans for the best outcome
• Develop ongoing long-term care plans/service plans and identify providers, specialists, and community resources
• Coordinate between members, families/caregivers, and care provider teams to ensure services are accessible
• Provide resource support for employment, housing, participant direction, independent living, justice, and foster care needs
• Monitor care plans, member status, and outcomes and recommend updates based on member needs
• Interact with long-term care healthcare providers and partners
• Collect, document, and maintain member information and care management activities for regulatory compliance
• Perform on-site visits as needed to assess member needs and collaborate with providers or resources
• Educate members and families/caregivers on procedures, provider instructions, service options, referrals, and healthcare benefits
• Provide leadership feedback on opportunities to improve quality of care and cost-effective service delivery
• Perform other duties as assigned

LTSS Service Care Coordinator

• Analyze integrated and extensive datasets to extract value and influence business decisions
• Collaborate with key business stakeholders to identify areas of value, develop solutions, and deliver insights to reduce overall cost of care and improve clinical outcomes
• Interpret and analyze data from healthcare provider, member/patient, and third-party sources
• Support execution of large-scale projects with limited direction from leadership
• Identify and perform root-cause analysis of data irregularities and present findings and proposed solutions to leadership and/or customers
• Manage multiple variable tasks and data review processes within targeted timelines
• Support design, testing, and implementation of process enhancements and identify automation opportunities
• Apply quantitative analysis, data mining, and data presentation expertise to understand customer interaction with analytic products
• Communicate findings and insights verbally and visually to non-technical business partners
• Engage independently with customers and business partners to gather requirements and validate results
• Present data-driven insights and recommendations to internal and external stakeholders, incorporating feedback
• Perform other duties as assigned
• Comply with all policies and standards

Data Analyst II, Healthcare Analytics

• Compile and analyze financial information for the company
• Lead various financial projects
• Review and validate contractor requests, extensions, statements of work, and professional services agreements
• Support project costing activities, including project coding, PeopleSoft IDs, cost plans, and funding alignment
• Prepare journal entries, accruals, reconciliations, and supporting schedules for labor and project accounting
• Analyze capital versus expense classification according to accounting policies and capitalization guidance
• Support labor reporting for internal labor, contractor labor, and professional services spend
• Identify and implement process improvements for reporting accuracy, efficiency, and financial controls
• Assist with audit requests, SOX compliance activities, and labor-related process and control documentation
• Partner with business leaders on labor demand, resource capacity, and funding requirements
• Develop and maintain financial models, dashboards, and management reports using Excel, Power BI, and other reporting tools
• Collaborate with Technology, Procurement, Portfolio Management, and HR to resolve financial issues and support decisions
• Prepare labor forecasts, budgets, and variance analyses for internal and external labor resources
• Analyze actual labor spend, labor utilization, contractor costs, and workforce trends
• Support monthly, quarterly, and annual financial planning, budget development, and forecast updates
• Monitor and report labor-related financial metrics