Centene Corporation

Account Executive

• Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory
• Provide greater access to health insurance, by providing education and assistance to Medicare individuals
• Distribute health education materials and arrange for health screenings
• Provide Facilitated Enrollment
• Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product
• Conduct home visits and personalized appointments as needed to complete the enrollment process
• Market Advantage on-site at hospitals, senior centers, assisted living facilities, community events and other sites as designated
• Keep informed and adhere to current information pertaining to marketing activity guidelines set forth by various regulatory agencies
• Conduct and participate in telemarketing/outreach efforts as required
• Attend and participate in sales meetings, training programs, conventions, and special events
• Complete applications in a timely and accurate manner

Medicare Sales Representative

Compliance

• Assist in maintaining Centene Corporation’s Compliance Program
• Provide regulatory interpretation, perform compliance reporting, lead special projects, and develop and implement compliance auditing and monitoring strategies
• Respond to external requests for information required by the organization for its regulatory filings
• Manage compliance reporting responsibilities and respond to inquiries from state and federal regulatory agencies
• Manage ethics and compliance projects or implementations
• Review and synthesize regulatory requirements and create policy and/or position statements
• Assist in managing annual code of conduct attestation and remediation
• Communicate state and federal requirements to internal and external clients
• Provide development guidance and assist in the identification, implementation, and maintenance of compliance policies, procedures and work instructions
• Assist in the identification, analysis, and resolution of compliance issues
• Maintain and review regulatory documentation necessary to maintain corporate standards
• Assist in developing, producing and conducting compliance training programs
• Perform periodic compliance audits, risk assessments and conducts related to ongoing compliance monitoring activities
• Assist health plans in managing relationships with regulatory agencies and seek to resolve policy issues which may negatively impact service to members
• Assist management with interim health plan compliance officer responsibilities
• Plan, direct and coordinate the implementation of Compliance Committee policy to ensure decisions are properly executed
• Serve as a company-wide resource and liaison on policies, contract issues and provisions, communications, workflow, and quality improvements initiatives

Senior Compliance Analyst – Marketplace Advisory

Analyst

• Analyzes and reviews the contact center's workload to build resourcing and optimize scheduling plans to meet business objectives and goals
• Analyzes the effectiveness and complex results of the contact center's schedule and provides scheduling methodology improvements to senior workforce scheduling team
• Participates in and leads meetings with stakeholders to analyze staffing plans and performance
• Works closely with management and other stakeholders to understand staffing requirements
• Analyzes contact center patterns, including volumes, trends, and contact center productivities
• Mentors and supports other members of the workforce scheduling team
• Advises on using a centralized vs. decentralized queue strategy
• Provides inputs to measure and analyze contact center staff productivity
• Ensures accurate records of contact center staff schedules
• Influences changes in policies and procedures for the workforce management unit

Senior Workforce Scheduling Analyst

Project Manager

• Plan, organize, monitor, and oversee complex projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives
• Manage the full project life cycle including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment and closure
• Utilize corporate and industry standard project management tools and techniques to effectively manage projects
• Assist with establishment and maintenance of corporate project management methodology and other department procedures
• Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans
• Provide leadership and effectively communicate project status to all stakeholders, may include written executive summaries
• Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks
• Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company's objectives
• Provide functional and technical knowledge across multiple business and technical areas
• Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation

Compliance Training & Education Project Manager

Customer Support

• serves as the first-line advocate that focuses on resolving inquiries, issues, or concerns for members and/or providers
• provides members and/or providers with timely, accurate, and personalized support on routine complaints
• mitigates and prevents complaints from being escalated to resolve in initial contact
• documents all member or provider information and communications for quality and performance tracking

Customer Service Advocate I – Korean Bilingual

• Serves as the first-line advocate that focuses on resolving inquiries, issues, or concerns for members and/or providers
• Leverages a variety of communication channels to provide members and/or providers with timely, accurate, and personalized support on routine complaints
• Receives and responds to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner
• Mitigates and prevents complaints from being escalated to resolve in initial contact
• Serves as the front-line resolution advocate on various member and/or provider inquiries, requests, or concerns
• Resolves basic problems by communicating the requested information regarding the assessment of the member or provider needs
• Maintains performance and quality standards based on established contact center metrics
• Provides customer service in a high pace contact center environment over the phone, via live chats and emails
• Documents all member or provider information and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications

Customer Service Advocate I – Cambodian Bilingual

Financial Planning and Analysis

• Compile and analyze Medicare financial information
• Lead various financial projects
• Cost effectively manage the utilization of services
• Develop measures to track, trend, and forecast impacts of organizational initiatives
• Create and analyze monthly, quarterly, and annual reports
• Identify trends and present findings to senior management
• Perform financial forecasting and reconciliation of internal accounts
• Handle complex financial analysis and present to upper management

Finance Analyst IV – Medicare

Software Engineer

• Design and develop the company’s Medicare Sales digital learning experiences
• Develop, implement, and update high-quality learning content in a variety of formats
• Identify adult learning models, methods and modalities that support the design strategy
• Conduct user research and assess business needs
• Design using latest design software and tools for rapid prototyping
• Responsible for technical quality and function of all courses

Digital Curriculum Developer

Manager

• Develops, assesses, and facilitates complex care management activities for primarily physical needs members
• Evaluates the needs of the member, barriers to accessing the appropriate care
• Develops ongoing care plans / service plans and collaborates with providers
• Identifies problems/barriers to care and provide appropriate care management interventions
• Provides ongoing follow up and monitoring of member status
• Collects, documents, and maintains all member information and care management activities
• Provides and/or facilitates education to members and their families/caregivers on disease processes

NICU Care Manager, RN

Clinical Operations

• Responsible for managing and tracking clinical projects that advance the objectives of strategic plan with key provider groups and/or hospital systems
• Works closely with the Regional Medical Director to analyze data and develop and implement key interventions to support the Triple Aim
• Serves as project leader for cross functional initiatives that are intended to drive performance improvement
• Facilitates the development of clinical reports and the delivery of data to key provider partners; develops internal reports to demonstrate progress
• Performs detailed analysis of data, workflows, policies, procedures and organization of staff, in order to execute initiatives

Clinical Program Manager

• Partner with the CMO in market level population health identification, strategy, evaluation, and monitoring
• Provide strategic leadership for population health internally and externally with various stakeholders
• Use analytics to drive development of interventions for unique populations
• Oversee performance of all UM functions
• Drive MLR initiatives locally in partnership with Finance
• Collaborate with SIU to identify patterns of potential fraud
• Develop comprehensive position papers to advocate for program enhancements
• Coordinate quality initiatives and activate local policies

Vice President, Population Health – Clinical Operations

Director

• Design, implement, and optimize innovative and value-based payment contracting strategies
• Collaborate with multiple functional health plan departments to build out a strategic payment innovation roadmap
• Lead implementation of prioritized initiatives in partnership with Provider Network Management, Medical Management, Product, Claims, Sales and Marketing, Finance and Actuarial teams
• Lead, coach, train, performance manage a team
• Lead the identification, development, work process design and implementation of new network provider innovation models
• Research Federal, State and competitor strategies on value-based payments
• Develops and implements provider network innovation and optimization standards and guidelines to increase market share, revenue growth, and quality outcomes
• Develops, implements and maintains a multi-year strategic roadmap for the health plan's value-based payments strategy
• Leads a cross-functional team and work across the health plan to implement targeted initiatives (bundled payments, hospital quality incentives, shared risk redesign)
• Collaborates with Networks team on payment innovation work

Director, Provider Payment Innovation – Provider Network Management

• Develop strategic partnerships between the health plan and the contracted provider networks
• Engage with providers to align on network performance opportunities
• Consultative account management and accountability for issue resolution
• Drive optimal performance in contract incentive performance, quality, and cost utilization
• Participate in the development of network management strategies
• Assist in the strategic implementation of new initiatives for performance improvement
• Serve as primary contact for providers
• Act as a liaison between the providers and the health plan
• Identify and deliver solutions to providers concerns and issues as needed
• Investigate, resolve and communicate provider claim issues
• Engage with and educate providers regarding policies and procedures
• Perform provider orientations and ongoing provider education
• Manages Network performance for assigned territory
• Evaluates provider performance and develops strategic plan to improve performance
• Drives provider performance improvement in various areas
• Present detailed HBR analysis and create reports for Joint Operating Committee meetings
• Develop proficiency in tools and educate providers on use of tools

Performance Manager

• Leads team of Provider Relations Representatives, Network Performance Advisors and/or Provider Relations Supervisors
• Develops Provider Relations Team to achieve market performance targets
• Conducts ride-alongs with Reps in the field
• Identifies team skill set deficiencies
• Monitors Provider Performance action plans
• Ensures compliance with enterprise provider performance and relationship model
• Responsible for understanding the differences between Risk and Value-Based contractual arrangements
• Responsible for understanding HEDIS and STARS measures
• Plans, prepares and executes effective group meetings/discussions
• Identifies areas of opportunity to improve Provider Satisfaction and Provider Experience
• Assists in monitoring and developing High Performing Practices

Senior Manager, Value Based Performance Management

Data Engineer

• Manages the overall data platform and infrastructure
• Mentors the team of data engineers
• Supports developing processes and expanding technology roadmap
• Plans features and measures outputs, ensuring quality products
• Derives analytical insights from various business contexts
• Communicates insights effectively to stakeholders
• Manages design and development of software and processes for data pipelines
• Optimizes availability of data to generate insights
• Translates technical business goals into designs
• Allocates resources to meet operating objectives
• Fosters a diverse and inclusive workplace