Centene Corporation

Financial Planning and Analysis

• Manage the department with respect to workflow, production, and quality standards
• Review and participate in budget and financial forecast processes
• Review and analyze reports, records, and directives
• Evaluate and update policies and procedures of the department to improve quality
• Prepare and analyze reports on departmental and organizational activities
• Develop and maintain financial models to support forecasting, workforce capacity planning
• Partner with operational leaders to translate business demand forecasts into staffing and financial plans aligned with organizational objectives
• Analyze workforce, operational, and financial performance metrics to identify trends, risks, and opportunities for improvement
• Prepare and present financial analyses, forecast updates, and variance explanations

Manager, Financial Planning

Analyst

• Analyzes the contact center's workload to build resourcing and optimize scheduling plans
• Analyzes complex scheduling information and develops staffing recommendations
• Develops staffing schedules to ensure maximum efficiency of resources to meet customer demand
• Analyzes and evaluates contact center patterns, including volumes, trends, and contact center productivities
• Identifies unexpected absences, deviations from schedules, and other operational disruptions
• Evaluates results of forecasted contact center workload to build resourcing and scheduling plans to meet business objectives
• Analyzes data using a centralized vs. decentralized queue strategy
• Evaluates how this strategy may impact key performance metrics and staffing plans
• Analyzes and evaluates key performance metrics for improvement and data-driven recommendations
• Assesses contact center staff’s productivity and prepares feedback for contact center supervisory staff
• Maintains accurate records of contact center staff’s schedules, time off requests, and other staffing-related information
• Ensures scheduled reports on the effectiveness and efficiencies of contact center
• Assists in developing policies and procedures for workforce management unit

Workforce Scheduling Analyst II

Security Engineer

• Responsible for defining, governing, and evolving the enterprise security architecture
• Ensure technology solutions are secure, scalable, compliant, and aligned with business and risk objectives
• Serve as the architectural authority for security design
• Provide leadership, governance, and strategic direction across cybersecurity initiatives
• Define and maintain the enterprise security architecture, including principles, standards, reference architectures, and design patterns
• Provide architectural oversight and approval for security designs across cloud, application, infrastructure, data, and AI platforms
• Lead threat modeling and architecture risk assessments
• Collaborate with teams to translate security requirements into implementable designs
• Establish and enforce security architecture governance
• Lead and develop a team of security architects and senior engineers

Senior Manager, Security Architecture

Compliance

• Responsible for the management and oversight of the data privacy compliance program to ensure compliance with applicable policies and regulations across the organization
• Represent the Privacy department in Enterprise level programs and initiatives
• Develop and maintain relationships with cross functional teams to promote a culture of privacy and compliance
• Implement standards and processes to ensure compliance with new and changing privacy regulations
• Manage, monitor and report on Enterprise Privacy vendors’ performance
• Monitor and audit privacy compliance program processes and documentation to ensure compliance with company policy and regulatory requirements
• Coordinate with other functional areas to address data privacy compliance issues and concerns that impact the business
• Coordinate investigations into data privacy and security incidents
• Develop, implement and manage corrective actions to remediate incidents of data privacy non-compliance
• Develop and maintain reporting metrics of data privacy department activities
• Conduct training on data privacy requirements and policies
• Mentor team members to improve knowledge and skillset related to data privacy program processes and requirements

Senior Manager, Privacy Compliance

Medical Director

• Assist the Vice President of Medical Affairs to direct and coordinate the medical affairs functions for the business unit
• Oversee the denials and appeals department
• May manage other medical directors
• Provide medical leadership for all utilization management, pharmacy, case management, disease management, cost containment, and medical quality improvement activities
• Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services
• Support the effective implementation of performance improvement initiatives for capitated providers
• Assist VPMA in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members
• Utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
• Participate in provider network development and new market expansion as appropriate

Senior Medical Director – YouthCare

Business Analyst

• Perform and lead various analysis and interpretation to link business needs and objectives for assigned function and implement process improvements
• Lead the support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
• Lead the identification and analysis of user requirements, procedures, and problems to improve existing processes
• Resolve issues and identify opportunities for process redesign and improvement
• Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements
• Evaluate risks and concerns and communicate to management
• Coordinate with various business units and departments in the development and delivery of training programs
• Develop, share, and incorporate organizational best practices into business applications
• Oversee all changes to departmental policies and procedures, including communicating and implementing the changes
• Serve as the subject matter expert on the assigned function product to ensure operational performance
• Ability to travel

Business Analyst IV – Integration Quality, User Acceptance Testing

Director

• Leads strategic business transformation programs with enterprise impact
• Acts as a trusted advisor and strategic partner to Centene leadership
• Assists with the business transformation team's strategy, execution/delivery methodology, and realizing business benefits across the enterprise portfolio
• Manages a team responsible for adhering to the department's Business Transformation Methodology
• Sources talent, coaches, trains, mentors, and provides feedback; conducts annual reviews and all matters required by HR
• Leads enterprise-wide transformation initiatives across Appeals & Grievances functions, partnering with senior leaders to standardize processes, drive governance, and improve performance outcomes
• Provides forward-thinking leadership to a team of Business Transformation Professionals in guiding the business to achieve operational efficiency
• Leverages superior knowledge of healthcare, business improvement/transformation, organization change management, customer experience, and strategy, to develop training and enforcement of the eBT methodology tools and techniques

Senior Director, Business Transformation, Appeals & Grievances

Communications

• Support the planning, development, and execution of clear, consistent, and compliant communications.
• Coordinate with subject matter experts and training teams to ensure accurate information delivery.
• Develop and distribute communication materials.
• Coordinate review and approval of communication materials with internal experts.
• Maintain knowledge of federal and state regulatory requirements for communications materials.

Senior Communications Specialist

Manager

• Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes
• Monitor business processes and systems to assure integrity and compliance in billing and claims payment
• Lead a team responsible for investigating fraud, waste and abuse referrals for prepay investigations
• Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis
• Attend state/federal meetings as required by specific contracts
• Review pre-payment cases with appropriate parties for the purposes of developing resolution strategies
• Prepare and distribute monthly and quarterly saving reports
• Participate in Appeals Committee, work groups and interdepartmental meetings

Manager, SIU Prepay Investigations

Vice President

• Responsible for developing and managing the provider network strategy for Centene Corporation
• Lead all aspects of provider network strategy including reimbursement strategy, contracting strategy, unit cost management, claims configuration and network operations
• Oversee network development staff and external consultants in the development of provider networks across expansion markets
• Lead health plans in periodic analyses of their provider networks from a cost, coverage, and growth perspective
• Provide leadership in evaluating opportunities to expand or change the network to meet Company goals
• Manage budgeting and forecasting initiatives for product lines to network costs and provider contracts
• Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations
• Lead initiatives to ensure periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy
• Lead development of fee schedules and rates for new and existing markets consistent with budget and premium revenue assumptions
• Support market expansion and M&A activities by leading provider contract analysis related to due diligence
• Assist health plan CEOs, network development, legal and finance teams in key provider contract negotiations and strategy
• Work collaboratively with Business Development on new markets and new product development initiatives
• Ability to travel
• Performs other duties as assigned

Vice President, Network Strategy – Management Value-Based Contracting

Business Operations

• identifies and facilitates enterprise-wide process improvement activities utilizing LEAN/Six Sigma methodologies
• mapping processes in Visio
• assessing process/procedural documentation needs
• identifying gaps and improvement opportunities
• manages documentation repositories in a decentralized environment
• performs annual documentation reviews to ensure accuracy and compliance
• document current state process workflows and procedures
• perform needs assessment within Business teams to identify gaps in documented process and procedures
• manage process and procedural content within content management source system(s)
• identify, develop, prioritize, and execute process improvement opportunities utilizing continuous improvement principles and LEAN/Six Sigma methodologies
• provide training to project teams and functional areas to assist with the implementation and maintenance of process improvement activities
• identify, communicate, and correct gaps in process performance and provide guidance to address these gaps

Business Process Improvement Manager

Procurement

• Manage vendor relationships and ensure vendor compliance with established internal and/or regulatory performance metrics
• Accumulate, monitor, and report on vendor performance metrics to business unit management
• Communicate expectations and vendor performance against established performance metrics to vendors, including development, implementation and follow up on annual vendor goals and targets
• Ensure applicable vendor performance improvement plans and/or corrective action plans are initiated and completed as expected
• Ensure vendors sustain required performance improvements/outcomes through verification audits
• Conduct oversight meetings which include vendors, internal partners, and other stakeholders as appropriate
• Oversee health plan participation in annual delegation audits
• Provide follow-through on audit deficiencies to assure corrective actions are implemented
• Facilitate communication to/from vendors and internal partners

Director, Vendor Management

Systems Engineer

• Drives the collaboration with business and IT stakeholders to translate complex business requirements into comprehensive functional and non-functional technical specifications
• Gathers and validates business / technology requirements
• Analyzes and verifies requirements for completeness, consistency, comprehensibility, feasibility, and conformity to standards
• Translates conceptual user requirements into functional requirements
• Creates systems and business process models, specifications, diagrams, and charts
• Communicates changes, enhancements, and modifications of business requirements to stakeholders
• Plans and coordinates user acceptance testing (UAT)

Senior Business Systems Analyst

Account Manager

• 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 with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution.
• Drive optimal performance in contract incentive performance, quality, and cost utilization.
• Serve as primary contact for providers and act as a liaison between the providers and the health plan.
• Triages provider issues as needed for resolution to internal partners.
• Investigate, resolve and communicate provider claim issues and changes.
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics.
• Perform provider orientations and ongoing provider education, including writing and updating orientation materials.

Provider Engagement Account Manager

• Oversight of the Gold Card Program to ensure effective performance and communication with stakeholders
• Develop and lead long term program development and enhancement initiatives
• Ensure subject matter expertise is infused into the program
• Support the integration of the program across all business units
• Ensure consistent integration of adaptive technology and expert team-based services
• Support in the financial analysis of the program performance and strategic plans