Centene Corporation

Clinician

• Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness
• Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines
• Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards
• Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria
• Analyzes BH member data to improve quality and appropriate utilization of services
• Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services
• Provides education to members and their families regarding ABA and BH utilization process
• Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies
• Performs other duties as assigned
• Complies with all policies and standards

Utilization Review Clinician – ABA

Communications

• Manage all state-wide activities related to marketing, communications, preventive health education and state initiatives
• Provide strategic solutions to state initiatives while meeting compliancy and deliverable timeline
• Manage the writing, design and production of member and provider newsletters, educational materials, handbooks, directories, manuals, member ID cards, promotional items and website content while maintaining Corporate brand and style guidelines and maintaining state compliancy
• Maintain and support the cultural competency program for the organization
• Review and submit state required deliverables
• Oversee staff to ensure that state requirement standards are met and programs are relevant to meeting the goals
• Serve as media contact and spokesperson on health plan specific issues and coordinate appropriate media responses with members of executive management
• Establish contacts and manage professional relationships with local vendors, agencies and community based organizations
• Work closely with all internal departments in order to achieve maximum outcomes in marketing initiatives and daily outreach activities
• Serve as liaison between Corporate Marketing & Communications and health plan adhering to company standards and the review and approval process

Manager, Marketing – Communications

Manager

• Develops, assesses, and facilitates complex care management activities
• Provides high quality, cost-effective healthcare outcomes
• Evaluates the needs of the member and recommends the best care plan
• Identifies barriers to care and provides appropriate interventions
• Coordinates care between the member, family, and care provider team
• Provides ongoing follow up and monitoring of member status
• Collaborates with providers to revise or update care plans as necessary
• Provides resource support for local services
• Performs education for members on healthcare options and benefits
• Collects and maintains member information for compliance

Care Manager, RN

Care Navigator

• Develops, assesses, and coordinates care management activities based on member needs
• Develops or contributes to the development of a personalized care plan/service plan for members
• Educates members and their families/caregivers on services and benefit options available
• Evaluates the needs of the member, barriers to care, and resources available
• Coordinates as appropriate between the member and/or family/caregivers and the care provider team
• May monitor progress towards care plans/service plans goals and/or member status
• Collects, documents, and maintains all member information and care management activities to ensure compliance
• May perform on-site visits to assess member’s needs

Care Coordinator

• Supports care management activities and teams assigned to members to ensure services are delivered
• Interacts with members by performing member outreach telephonically or through home-visits
• Coordinates care activities based on the care plan/service plan
• Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan
• May support performing service assessments/screenings for members and documenting the member’s care needs
• Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards
• Provides education on benefits and resources available

Care Coordinator II

Financial Planning and Analysis

• Compiling and analyzing labor financial information for the company
• Assist with the review and validation of contractor requests, extensions, statements of work (SOWs), and professional services agreements
• Support project costing activities, including review of project coding, PeopleSoft IDs, cost plans, and funding alignment
• Prepare journal entries, accruals, reconciliations, and supporting schedules related to labor and project accounting
• Perform analyses related to capital versus expense classification in accordance with accounting policies and capitalization guidance
• Support labor reporting processes, including internal labor, contractor labor, and professional services spend
• Identify and implement process improvements to enhance reporting accuracy, efficiency, and financial controls
• Assist with audit requests, SOX compliance activities, and documentation of labor-related financial processes and controls
• Partner with business leaders to evaluate 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 cross-functional teams including Technology, Procurement, Portfolio Management and HR to resolve financial issues and support decision-making
• Assist with the preparation of labor forecasts, budgets, and variance analyses for internal and external labor resources
• Analyze actual labor spend, labor utilization, contractor costs, and workforce trends to identify risks and opportunities
• Support monthly, quarterly, and annual financial planning processes, including budget development and forecast updates
• Monitor and report on labor-related financial metrics, including headcount, contractor spend, labor capitalization, and project investment costs.

Finance Analyst II

Business Analyst

• Perform various analysis and interpretation to link business needs and objectives for assigned function
• Partner with IT, program managers, SMEs, and recovery vendors to translate operational needs into system enhancements
• Develop business requirements, manage issue resolution, and ensure timely support of recovery operations
• Monitor recovery operations, inventory, and reporting tools to identify issues and savings opportunities
• Lead defect investigation, user acceptance testing (UAT), and implementation of quality solutions to improve accuracy and performance
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation
• Identify ways to enhance performance management and operational reports related to new business implementation processes
• Develop and incorporate organizational best practices into business applications
• Lead problem solving and coordination efforts between various business units
• Assist with formulating and updating departmental policies and procedures

Business Analyst II – Recovery Platform Operations

• Develops, assesses, and coordinates care management activities based on member needs
• Develops or contributes to the development of a personalized care plan/service plan for members
• Educates members and their families/caregivers on services and benefit options
• Evaluates the needs of the member and recommends and facilitates the best outcome
• Provides psychosocial and resource support to members/caregivers through advocacy and care coordination
• Coordinates between the member and care provider team to ensure accessibility of care
• May monitor progress towards care plans and collaborate with healthcare providers
• Collects, documents, and maintains all member information and care management activities
• Performs on-site visits to assess member’s needs and collaborate with providers as appropriate

Care Navigator – Foster Care

Medical Director

• Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit
• Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities
• Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services
• Supports effective implementation of performance improvement initiatives for capitated providers
• Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members

Supervisor

• Supervises the care management team and the care management of members to promote quality and efficacy of care management delivery
• Supervises day-to-day escalations and care management issues related to members or providers
• Monitors and reviews care management required documentation to maintain and ensure compliance with federal and state regulations and contractual agreements
• Assigns caseloads and work assignments to care management team based on state requirements, care management staff experience, and member needs
• Works with senior management on escalated and complex care cases, and provides guidance to junior team members to address member concerns
• Educates and provides resources for care management team on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers
• Evaluates care management team performance and provides feedback regarding performance, goals, and career milestones
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
• Provides coaching and guidance to care management team to improve member and provider experience and high-quality care
• Assists with onboarding, hiring, and training care management team members
• Leads and champions change within scope of responsibility

Supervisor, Care Management

• Direct and oversee all training activities, including training assessment and evaluation, material development, and training facilitation
• Partner with subject matter experts to develop relevant training programs that may utilize different instructional practices
• Lead the development and implementation of appropriate training curriculum across the business unit
• Conduct trainings as applicable
• Develop specific learning and development initiatives to blend technical, business and cultural responsibilities by focusing on succession planning, career development and performance management
• Conduct gap analysis in an effort to identify organization effectiveness issues
• Make recommendations for improvement through the use of specific training and development programs
• Confer with appropriate management and staff to gain knowledge of work situations, processes, regulations, business initiatives and technologies in order to develop appropriate training programs/materials
• Oversee and coordinate training efforts to meet training demands
• Collaborate with Human Resources to assist with the delivery of New Employee Orientation, on-boarding training and employee development
• Oversee online interactive training initiatives from development to facilitation
• Analyze and evaluate training effectiveness and ROI and provide reports and recommendations to management
• Identify and implement cost savings while maintaining effective training programs
• Oversee the auditing of team results, identify gaps in training and implement improvements in training programs
• Determine appropriateness of contracting with outside vendors to accomplish the organization’s training goals and objectives
• Develop comprehensive training calendar for internal offering and maintain a library of external resources

Director, Clinical Training

Data Analyst

• Analyze integrated and extensive datasets to extract value, which directly impacts and influences business decisions
• Work collaboratively with key business stakeholders to identify areas of value, develop solutions, and deliver insights to reduce overall cost of care for members and improve their clinical outcomes
• Interpret and analyze data from multiple sources including healthcare provider, member/patient, and third-party data
• Lead the planning and execution of large-scale projects and new reporting tools, translating business goals into actionable solutions
• Identify and resolve data, process, and technical issues and communicate root-cause with stakeholders as appropriate
• Partner cross-functionally at all levels of the organization and effectively, both verbally and visually, communicate findings and insights to non-technical business partners
• Independently engage with business leaders to understand market-specific levers and constraints
• Leverage enterprise reporting tools to rapidly deliver data-driven insights and recommendations
• Research key business problems and proactively identify opportunities for cost and utilization improvements through quantitative analysis
• Communicate and present data-driven insights and recommendations to both internal and external stakeholders, soliciting and incorporating feedback when required
• Mentor junior analysts on analytic best practices and business need fulfilment
• Delegate tasks to junior analysts, providing guidance and validation where required
• Performs other duties as assigned
• Complies with all policies and standards

Data Analyst IV, Healthcare Analytics

Analyst

• Research, develop, design, analyze, evaluate, and administer ICHRA benefit plans and programs
• Administer multi-state employee benefits including ICHRA, 401(k), Health and Welfare, Wellness, Group Risk, FSA, PTO, EAP, and executive benefits
• Assist in research, development, renewal and communication of benefit plans
• Interpret, review, and update benefits policies and procedures to ensure standardization, legal compliance and improved efficiency
• Manage carrier and vendor relationships, including development and analysis of RFP information
• Research and resolve complex benefit issues using multiple systems, tools and resources
• Administer federal, state and government regulatory filings and processes (i.e., 5500s, SARs, audits, non-discrimination testing, etc.)
• Review and analyze various benefit costs and recommend action plans
• Act as liaison between carriers and HRIS vendors for benefit support related items
• Review, transmit and resolve issues with eligibility files for benefit plan vendors
• Participate in creating and presenting training sessions for field and corporate human resources generalists
• Performs other duties as assigned
• Complies with all policies and standards

Senior Benefits Analyst – ICHRA

• Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members
• Supervises day-to-day activities of utilization management team
• Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
• Collaborates with utilization management team to resolve complex care member issues
• Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
• Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
• Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
• Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
• Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
• Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones
• Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
• Assists with onboarding, hiring, and training utilization management team members
• Leads and champions change within scope of responsibility
• Performs other duties as assigned
• Complies with all policies and standards

RN Supervisor, Appeals, Managed Care, UM

• Responsible for supporting the development and execution of executive communications and corporate messaging strategies
• Drafts communications including emails, intranet content, talking points, and speeches for senior executives
• Evaluates and helps manage internal and external engagement opportunities
• Manages and executes social media content (including LinkedIn) in alignment with defined strategy and guidance
• Partners with Corporate Communications to ensure executive messaging aligns with enterprise messaging frameworks and priorities
• Supports the dissemination and adoption of messaging tools across business units and functions
• Conducts research and develops supporting materials and proof points to reinforce key messages
• Partners with stakeholders to ensure messaging is actionable and relevant at the local and functional level