Centene Corporation

Clinical Operations

• Oversees the development and implementation of clinical initiatives and/or programs to improve care coordination, efficiency, and health and quality outcomes
• Oversees the clinical operations team and works with senior leadership to ensure all clinical processes are consistent with National Committee for Quality Assurance (NCQA) guidelines, state mandates, and/or government contract requirements
• Reviews data analyses related to utilization, outcomes, safety, and costs to determine trends and identify areas of improvement for clinical initiatives and/or programs
• Develops, implements, and oversees clinical plans, policies, and procedures needed for strategic initiatives, programs, and improve processes and/or health and quality outcomes based on collected data
• Identifies process improvements for clinical initiatives and/or programs and presents them to senior leadership team
• Manages and tracks achievements against goals and objectives for clinical operations team
• Manages and coordinates the training of clinical operations team members to ensure adequate training and implementation of clinical initiatives and/or programs

Senior Manager, Clinical Operations

Procurement

• Leads the integrity and governance of Centene's and/or its vendors corporate ethics and compliance program
• ongoing oversight and analysis of regulatory compliance practices
• Collaborates with internal teams and external vendors or subcontractors to promote contract compliance and uphold program integrity
• Oversee the management of the entire contract lifecycle, from drafting to finalization
• Conducts reviews, audits, and assessments of vendor relationships to ensure adherence to Centene and Government-sponsored health care program Requirements.
• Collaborates with business owners and vendors to drive process improvements
• Leads the timely, consistent, and accurate communication of state and federal regulatory updates impacting Medicaid and Marketplace regulatory filings
• Prepares, organizes, and packages subcontractor files for approval/notification
• Develop clear, accurate and timely written reports detailing oversight and monitoring findings and recommendations
• Ensures all supporting documentation and workpapers meet Centene and department standards
• Partners with internal departments and subcontractors to route compliance concerns to the appropriate channels for investigation and resolution
• Supports regulatory notifications and documentation of approvals/notifications

Senior Compliance and Vendor Management Oversight Specialist

Director

• Creates and implements Network Transformation initiatives across a market
• Develops Provider Relations Management team
• Conducts field rides with Provider Relations Representatives
• Identifies team skill set deficiencies and implements proper professional development plans
• Monitors Provider Performance action plans
• Drives improvement of provider performance by analyzing, interpreting and communicating financial, utilization and quality metrics
• Establishes and leads collaborative effort with internal cross-functional market and shared services departments
• Plans, prepares and executes effective group meetings/discussions
• Assists in monitoring and developing High Performing Practices

Senior Director, Value Based Performance Management

Engineer

• Responsible for the design, implementation, and support of SailPoint IdentityIQ (IIQ) solutions
• Lead complex integration and automation initiatives across enterprise environments

Lead IAM Engineer

Medical Director

• Provide medical oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members
• Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations
• Provide leadership and expertise in the development, implementation and interpretation of medical review and quality related policies and guidelines
• Provide oversight and direction for staff and provider training and education
• Promote positive relations with the local medical community, including periodic consultation with providers or prescribers
• Review case management data, identifies trends and gaps in care and recommends corrective actions
• Review all quality of care issues and oversees the development and implementation of processes for improvement
• Monitor performance indicators to ensure the delivery of cost-effective care within quality standards
• Monitor member and provider satisfaction and recommends and implements changes to improve satisfaction levels
• Work collaboratively to develop corporate clinical care standards and medical practice policies
• Provide medical guidance to the Medical Management department

Chief Medical Officer

Vice President

• Responsible for the ideation and execution of the ICHRA strategy
• Collaborates with multiple disciplines across the enterprise
• Lead the development and execution of the strategic plan
• Builds strong cross-functional relationships to carry out key projects
• Assists with strategic prioritization, execution, and accountability
• Supports the product in strategy, planning, M&A and business development activities
• Engages and collaborates with senior leadership teams

Vice President, Health Solutions

Analyst

• Facilitate and manage the tracking of policy/legislation updates and perform analysis of policy changes
• Research health policy and legislation updates
• Develop position papers, talking points, meeting summaries, policy briefs, fact sheets, and presentations for senior executives
• Engage Centene business units to form policy positioning and draft comment letters/RFIs to CMS and other federal agencies

Health Policy Analyst

Support Engineer

• Engages Subject Matter Experts (SMEs) from other IT groups on complex issues
• Uses Incident and Knowledge data to identify repetitive issues
• Works with appropriate personnel to create knowledge articles and solutions to reduce frequent occurrences
• Reviews ticket queue and works to reduce ticket count
• Answers customer phone calls
• Performs other duties as assigned
• Complies with all policies and standards

Service Desk Support Analyst II

Manager

• responsible for driving the product performance function for assigned products across multiple lines of business
• serve as the primary contact for new product implementations and expansion of existing product lines
• develop policies and procedures and execute the specific business plan for new and existing products
• oversee the review of product performance, the analysis of the performance of products, and the coordination of product improvement initiatives
• Monitor and manage commercial product portfolio performance for the segment(s)

Manager, Product Performance

Solutions Engineer

• Maintains an important strategic role in the planning, conceptualizing, configuring, and building 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 from an operational perspective
• Acts as a subject matter expert providing advice, support and guidance as needed and serves as a mentor to colleagues
• Must have the ability to be self-sufficient
• Lead projects, conduct requirements gathering; maintain communication with stakeholders during solution development
• Writes code for software programs and applications, working with classes, using inheritance and virtualization, and following best programming practices
• Performs complex research and advanced analysis; find/create best solutions to stakeholder requests or problems; identify the best method or tool to develop solutions
• Collaborates with and mentor peers on development and solution strategy; regular code reviews and pull requests; team partnership to identify efficient and effective scalable product solutions

Business Solutions Developer IV

• Own end‑to‑end development of multi‑signal detections (endpoint, identity, network, cloud/SaaS) using Splunk (SPL), Microsoft Sentinel/Defender & Azure (KQL), FortiNDR Cloud (IQL), and Databricks (SQL)
• Translate threat intel (IOCs/TTPs, ATT&CK mapping) into battle‑tested analytics; convert vetted Sigma rules to SPL/KQL where applicable
• Implement version control, change notes, suppression logic, and CI/CD pipelines for detections; champion detection replay/backtesting to improve precision/recall and reduce noise
• Establish and maintain reusable detection content libraries, curated views/tables, and documentation/runbooks that accelerate operations
• Lead data onboarding and schema alignment; articulate coverage plans and quality gates for priority threats and control gaps
• Work directly with SOC/CSMT and CSIRT to tune, triage, and validate detections; convert hunts into detections and run purple‑team validations
• Provide technical mentorship for DE I/II; conduct peer reviews of detection logic; contribute to sprint planning aligned to quarterly OKRs
• Influence roadmap, standards, and governance for the DE program in partnership with the Principal/Lead Detection Engineer

Senior Detection Engineer

Compliance

• Design and implement programs, policies, and practices to ensure State and Federal program contract compliance
• Represent Corporate Compliance at meetings with the State and Federal Regulators
• Conduct compliance audits and monitoring activities to assess adherence to local, state, and federal regulatory requirements
• Identify areas of non-compliance and the need for corrective action plans
• Serve as a primary point of contact for Compliance professionals at provider practices
• Assist management with enforcement actions and disciplinary measures in instances of non-compliance
• Identify and implement process improvements
• Maintain subject matter expertise in auditing, monitoring, and regulatory compliance requirements
• Support the maintenance of the compliance risk assessment process
• Provide guidance and support for the execution of the annual audit and monitoring plan.

Senior Compliance Administrator

Actuary

• Conduct analysis, pricing and risk assessment to estimate financial outcomes
• Provide expertise and technical support in matters related to the successful and financially sound operations of the company's health plan businesses
• Develop and review actuarial pricing assumptions for off-exchange products designed for ICHRA
• Partner with cross-functional teams to ensure accurate and timely actuarial pricing
• Make actuarial pricing recommendations and build consensus with leadership
• Provide managerial oversight and mentorship to team members

Actuary Manager – ACA Pricing

• Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit
• Provide medical leadership of all for utilization 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, ensuring timely and quality decision making
• Support effective implementation of performance improvement initiatives for capitated providers
• Assist Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members
• Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements
• Assist the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership
• Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes
• Collaborate effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
• Participate in provider network development and new market expansion as appropriate
• Assist in the development and implementation of physician education with respect to clinical issues and policies
• Identify utilization review studies and evaluate adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components
• Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care
• Interface with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality
• Review claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment
• Develop alliances with the provider community through the development and implementation of the medical management programs
• May represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues
• Represent the business unit at appropriate state committees and other ad hoc committees
• May be required to work weekends and holidays in support of business operations, as needed

Child Behavioral Medical Director

Chief Technology Officer

• Responsible for leading the technological strategy, execution, and innovation across Centene's markets and oversee the IT operations and strategies within the Market.
• Collaborate with key business and technology stakeholders to envision, develop, and implement leading technology-enabled business solutions.
• Develop and maintain a comprehensive information technology roadmap, outlining the required IT infrastructure, operating platforms, and tools.
• Conduct research, competitor analysis, and customer surveys to gain a deep understanding of the market landscape and customer needs.
• Develop and implement IT solutions that directly address market demands and enhance the organization's market position.
• Build and maintain relationships with key business partners, clients, and stakeholders.
• Oversee the end-to-end solution development lifecycle, from ideation to launch.
• Leverage data analytics and insights to drive informed decision-making throughout the solution development process.
• Lead and manage a team of IT and Solution professionals, providing guidance, mentoring, and performance management.
• Partner with Chief Information Security Officer (CISO) to identify and mitigate IT-related risks.
• Collaborate with external vendors and suppliers to evaluate and select technology solutions that support market objectives.
• Develop and manage the IT budget for activities, ensuring optimal allocation of resources.
• Stay abreast of emerging technologies, industry trends, and best practices in IT and market strategies.