Centene Corporation

Operations

• Identify and implement enterprise wide process improvement activities utilizing LEAN/Six Sigma, Plan-Do-Study-Act (PDSA) or similar methodologies to support business infrastructure and procurement of new business opportunities
• Support the development, prioritization and execution of performance improvement projects utilizing LEAN/Six Sigma, PDSA or similar methodologies for all process improvements
• Assist with the implementation and training of functional areas regarding process engineering maintenance plans and staff trainings to improve effectiveness
• Collect, monitor and evaluate project key performance metrics and develop project status reports
• Facilitate cross functional improvement teams following DMAIC (Define, Measure, Analyze Improve Control) roadmap or similar improvement process
• Communicate gaps in process designs and implementations to upper management
• Performs other duties as assigned
• Complies with all policies and standards

Process Improvement Specialist

Manager

• Performs care management duties to assess, plan and coordinate aspects of medical and supporting services across the continuum of care for post-discharge members
• Completes medication review for pre-admission and post-discharge reconciliation
• Works with the care management and coordination teams to identify transition support services
• Evaluates the needs of the member by completing post discharge assessments for members transitioning from healthcare facilities
• Develops a care/service plan and collaborates with discharge planners, providers, specialists, and interdisciplinary teams to support member transition and discharge needs
• Assesses member current health status, resource needs, services, and treatment plans and provides appropriate interventions
• Facilitates the transition into active care management based on member needs
• Provides or facilitates education and resource materials to members, authorized caregivers, and providers to promote wellness activities to improve member overall quality of care
• Facilitates services between Primary Care Physician (PCP), specialists, medical providers, and non-medical resources as necessary to meet the medical and socio economic needs of members
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations
• Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner

Care Manager, Transition of Care (RN)

IT Support

• Manage complex, time-sensitive compliance workflows (e.g., regulatory deliverables tracking, policy and documentation governance, audit/exam readiness facilitation, issue intake, and committee operations)
• Ensure work is executed accurately, consistently, and in alignment with internal controls and healthcare regulatory requirements
• Serve as a trusted partner to Compliance leaders and cross-functional stakeholders, synthesizing information for decision-making, escalating risks and barriers, and driving process improvements that strengthen regulatory audit readiness
• Lead Compliance intake and work orchestration (e.g., presentation, requests, attestations, disclosures, incidents, and general inquiries), including triage, prioritization, assignment, and follow-through; identify trends and recommend upstream fixes
• Own compliance documentation management practices, including record accuracy, version control, controlled templates, and evidence traceability in alignment with retention and internal control requirements
• Serve as a lead coordinator for audit, monitoring, and regulatory readiness activities by managing evidence request workflows, maintaining evidence libraries, coordinating stakeholder responses, and escalating risks to timelines, completeness, or quality
• Manage regulatory and obligation tracking cadences by maintaining calendars, trackers, and dashboards; perform quality checks on inputs, reconcile status with owners, and provide concise leadership-ready reporting
• Run end-to-end governance logistics for compliance committees and working groups: develop agendas with leaders, compile and quality-check materials, document decisions/action items, and drive closure through proactive follow-up and escalation
• Support policy and procedure governance by coordinating drafting and review cycles, facilitating approvals, managing publication/distribution, and maintaining an audit-ready history of versions and approvals
• Develop and deliver routine and ad hoc compliance reporting; analyze drivers, identify risks, and propose corrective actions or process improvements
• Coordinate compliance communications and training logistics (scheduling, rosters, completion follow-up, and distribution of approved materials); track completion, identify gaps, and escalate non-compliance
• Apply sound judgment in handling sensitive information; partner with Compliance, Privacy, and Security to ensure appropriate access controls, least-privilege sharing, and secure transmission and storage of data and evidence
• Design and maintain standard work (SOPs, job aids, checklists, templates) for compliance operations; lead continuous improvement efforts to reduce cycle time, improve quality, and strengthen control effectiveness
• Serve as a primary point of contact for compliance operations processes; advise stakeholders on requirements and timelines, resolve issues independently when possible, and escalate complex risks or decisions to leadership
• Travel as needed to attend and participate in onsite meetings
• Performs other duties as assigned. Complies with all policies and standards.

Process Improvement Specialist

Care Manager, Transition of Care (RN)

Compliance External Audit Administrator