Centene Corporation

Learning and Development

• Manage provider communications and training activities for assigned business unit
• Provide strategic solutions to business needs to include individual and group training needs while complying with state regulatory, contractual, and deliverable requirements
• Manage the writing, design and production of provider newsletters, provider educational materials, Provider Network Management Plans, manuals, and website content while adhering to Corporate style guides and complying with state-mandated regulations
• Serve as liaison between Corporate Marketing & Communications and other business units, adhering to company standards and the review and approval process
• Review and audit provider communications and training material for accuracy
• Develop training schedules and regularly evaluate core competencies associated with training initiatives
• Review and revise policies, procedures and/or work processes to ensure development and adherence to best practices by the provider network management departments
• Develop and administer role-based training programs, including the development of training material such as desktops, live demonstrations, FAQs, document templates, multimedia visual aids, video tutorials, and reference libraries to employ technologies and enhance training development programs specific to all provider network management departments
• Manage client relationship management software and department inboxes, attend corporate training relevant to all provider network management departments and other duties as assigned

Provider Engagement Communications – Training Specialist

QA Engineer

• Conducting audits of the UAS assessments and related documentation/forms;
• Review, monitor and train staff in the Long Term Care Department.
• Review care management activities/records of the Care Management Teams and/or activities/clinical documentation submitted by the Intake Specialist.
• Confirm accuracy and monitor timeliness in accordance with Fidelis Care’s policies and regulatory standards.
• Ensuring adherence to departmental and regulatory data integrity standards and requirements.
• Create, analyze, report and maintain metrics and processes in support of department and all relevant NYS programs and product lines.
• Summarize findings and report to applicable management, training and retraining staff accordingly.
• Spend time in the field while reviewing Intake Specialist work, actively coaching and developing staff with real time training and feedback.
• Review clinical documentation to ensure quality standards and accuracy.
• Maintain a tracking tool logging unacceptable areas in workflow and staff documentation performance.
• Conduct monthly one-to-one sessions with Assessment nurses for re-education on best practices and clinical documentation.
• Participate in educational and management meetings for improving clinical core measures.

Quality Assurance RN – LTC

Communications

• Assist in the planning, implementation and evaluation of the state-wide marketing & communication program while promoting a favorable public image of the company and each of its product lines
• Assist in the design, review and revision of all health-related materials distributed to members while ensuring appropriateness of content, readability and translations
• Assist in the development, promotion and implementation of statewide initiatives including outreach events, healthcare education, and incentive programs
• Order and track promotional items for all products and all service areas while ensuring budget compliance and reporting financial impact
• Ensure the completion of monthly outreach calendars by regional outreach staff for all service areas
• Serve as a contact for community agencies, businesses, fundraisers, community events etc.
• Research data, construct ideas, lay out artwork, and/or represent employer directly before the public
• Prepare news releases, fact sheets and compose letters as needed
• Performs other duties as assigned

Marketing and Communications Specialist

Director

• The Senior Director, Healthcare Analytics leads analytic service delivery by aligning strategic objectives with the development of tools and capabilities
• Prioritize and direct the planning and execution of enterprise-wide analytics projects and strategic initiatives
• Provide senior leadership support and partnership to development efforts between business and technical partners
• Interface with leadership to ensure effective communication and visibility of strategic intent to analytic teams
• Manage executive customer expectations and relationships
• Serve as a primary domain contact as well as key point of escalation and accountability to ensure customer partnership and satisfaction
• Guide and partner with leaders across analytic domains to ensure strong partnerships, align all business needs, leverage cross-functional skills
• Mentor, manage, and ensure the continuous development of a team of leaders and analysts

Senior Director, Healthcare Analytics – Value Based Contracting

Program Manager

• Support and lead high-impact, enterprise-level programs
• Improve provider quality performance and patient outcomes through data-driven strategies
• Partner with executive leadership, quality, analytics, IT, and provider-facing teams
• Design, scale, and operationalize initiatives that advance value-based care
• Optimize performance metrics and deliver measurable ROI
• Manage multiple projects through full project life cycle process
• Maintain detailed project documentation including action items and risk mitigation plans
• Provide leadership and effectively communicate project status to stakeholders
• Negotiate with project stakeholders to identify and secure resources
• Lead cross-functional meetings with various functional areas

Provider Performance/Analytics Program Manager

Operations

• Managing, directing and supporting the dental operations for Medi-Cal, Healthy Families and Medicare members
• Ensuring compliance with Department of Health Services (DHS) and Healthy Families MRMIB contracts
• Monitoring Health Net's performance under its dental services contracts
• Overseeing Health Net's dental administration functions performed by third party administrator
• Acting as point person for provider relations and inquiries
• Maintaining and expanding provider network through contract negotiations
• Ensuring that the dental care provided meets acceptable standards
• Performing utilization review by reviewing claims and encounter data
• Developing and implementing policies and procedures for the dental plan
• Assisting in grievance resolution related to quality of care under the dental plan
• Actively participating in plan grievance procedures

Dental Operations Manager

Manager

• Develops, assesses and coordinates holistic care management activities.
• Evaluates member service needs and develops or contributes to development of care plans/service plans.
• Evaluates the needs of the most complex and high risk members with mental/behavioral health needs.
• Acts as liaison and member advocate between the member/family, physician, and facilities/agencies.
• Supports members with primarily mental/behavioral health needs.
• Performs frequent home and/or other site visits to assess member needs and collaborate with resources.
• Provides and/or facilitates education to long-term care members and their families/caregivers.
• Provides subject matter expertise and operational support for relevant mental and behavioral health-focused activities.
• Educates on and coordinates community resources.
• Provides coordination of service authorization to members and care managers for various services based on service assessment and plans.
• Ensures appropriate referrals based on individual member needs and supports the identification of providers, specialists, and community resources.
• Maintains accurate documentation and supports the integrity of care management activities in the electronic care management system.

LPC, LCSW, Psych RN – LTSS Service Care Manager

Application Engineer

• Manages the team members accountable for designing, developing, and implementing complex enterprise software solutions.
• Collaborates closely with technical and non-technical roles to provide design, technical analysis, development/configuration, testing, implementation, and support expertise.
• Serves in a team leadership capacity with large-scale Application Development projects / programs
• Leads the build-out or expansion of coding standards initiatives.
• Reports application progress and outcomes.
• Provides coaching and career development planning to junior Application Developers.
• Coordinates the work of 3rd party Development teams and holds 3rd party vendors accountable to standards, policies, and performance expectations.
• Identifies and evaluates risks and participates in mitigation and control activities.
• Partners with Security and SRE teams to ensure all security and change management policies are followed.
• Assists in the design and development of proof of concept and prototype application environments.
• Manages hiring and training of new and existing staff, conducts performance/salary reviews, and provides leadership, technical guidance and coaching to Developers.

Manager, Application Development Engineering

DevOps Engineer

• Helps lead projects that are focused on managing and maintaining optimum platform infrastructure performance, reliability, and security using SRE practices
• Develops complex services to automate monitoring activities and provide critical information to facilitate response and resolution of performance and availability issues and incidents
• Troubleshoots and analyzes service disruptions to determine the root cause of issues and develop solutions for improved reliability
• Leads more complex projects focused on building and maintaining observability/monitoring for the application

Senior Site Reliability Engineer

Solutions Engineer

• Plans, conceptualizes, configures, and builds solutions that solve common challenges within the business by using technological tools or programs
• Conducts research and requirement gathering to determine customer needs and drive strategy and oversee the development process
• A cross-functional role that encompasses a broad range of business knowledge and technical skillsets, working in collaboration with multiple teams and specialists
• Takes an active role in design, development, testing, troubleshooting and maintenance
• Writing code for software programs and applications using inheritance and virtualization following best programming practices
• Performs complex research and analysis to find best solutions to stakeholder requests or problems using best method or tools to develop solutions
• Conducts meetings to gather requirements and updates on ongoing projects
• Maintains communication with stakeholders during solution development
• Collaborates with peers on development and solution strategy to identify the most efficient and effective product solutions
• Performs regular code reviews and requests
• Performs other duties as assigned
• Complies with all policies and standards

Business Solutions Developer I

Project Manager

• Bring structure and momentum to work that matters as part of the Quality Member Experience & Insights Team
• 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

Project Manager III – Vendor Management

• Lead large-scale, cross-functional programs supporting UM turnaround time (TAT) governance and improvement
• Oversee all aspects of UM TAT program planning, management, and execution
• Create comprehensive timelines and ensure project teams develop and maintain deliverables
• Drive complex UM regulatory alignment initiatives by coordinating the work of project managers and business analysts
• Create and maintain executive-level dashboards and scorecards that track turnaround time performance
• Partner with analytics teams to develop ongoing post-implementation reporting that monitors TAT outcomes
• Prepare and deliver concise, decision-ready materials for Program Steering Committees and Executive Leadership
• Serve as the first point of escalation for TAT issues; work directly with project teams to resolve operational, process, or technology barriers
• Create and deliver best-practice guidance, standard workflows, and training related to TAT expectations

Program Manager – Authorization Turnaround Time Governance

Data Scientist

• Develops scalable software solutions utilizing statistical, artificial intelligence (AI) and machine-learning (ML) modeling approaches in support of Fraud, Waste, & Abuse (FWA) detection
• Identifies, accesses, compiles, and uses internal and external sources of relevant data
• Performs research and testing to develop machine learning algorithms and predictive models
• Conducts and reviews model training and evaluation
• Integrates, tests, tunes, and monitors solutions
• Design and develop data models to predict member outcomes or future impact of key member decisions
• Design and construct analysis tools that extract, and analyze data and store analytical results in an appropriate format for business needs
• Conduct exploratory data analysis from complex data sources and build key data sets to support Centene’s mission
• Evaluate and design experiments to monitor key metrics and identify improvement opportunities
• Develop mathematical and statistical models to distinguish relevant content or events and recognize patterns
• Participate in presentations and communicate results of analysis and findings
• Participate in the design of automated, operational analytics processes to achieve scale and durability of analysis processes
• Validate and measure the outcomes of health management programs using SAS, R and other tools, to include provider data, claims data, membership data
• Manage multiple projects as assigned
• Assist with training Data Analysts.

Data Scientist II – Fraud, Waste and Abuse

Financial Planning and Analysis

• oversee the maintenance of accurate financial records
• preparing the monthly close process
• assist with ad hoc healthcare analytics requiring SQL knowledge
• ensure that timely and accurate reports are generated
• produce and analyze complex financial and statistical reports
• generate and review ad-hoc reports related to quality, cost and effectiveness of healthcare services
• gather and prepare analysis based on information from various sources and financial reports
• provide financial and business analysis as required
• determine appropriate actions and present to upper management
• develop a thorough understanding of healthcare practices and procedures

Manager, Finance – Medicare/Medicaid/SQL

• 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
• Develops a personalized care plan / service plan for long-term care members
• Evaluates the service needs of the most complex or high risk/high acuity members
• Monitors care plans / service plans and/or member status
• Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments
• Provides and/or facilitates education to long-term care members and their families/caregivers