Centene Corporation

Analyst

• Assist in the execution of the organizations Value Based Payment contracting strategies (VBP)
• Responsible for working with VBP AVP, VBP Managers and other cross functional teams in management of multiple VBP relationships
• Communicate the status of each VBP relationship to the VBP team
• Recommend reporting enhancements based on VBP partner feedback
• Prioritize and escalate VBP issues to the AVP and Managers
• Develop strategies and action plans to eliminate aberrant utilization
• Assist internal and external VBP meetings to resolve issues
• Manage VBP activities, including data analysis, problem resolution

Analyst, Value Based Payment Initiatives

Director

• serve as a critical resource in supporting, managing and driving strategic projects and initiatives
• support senior management in executing business strategies
• direct the strategic planning process and establish key processes
• monitor and manage key deliverables of the strategic plan
• build strong cross-functional relationships to implement business strategies
• provide project management for implementation of key initiatives
• interact closely with business leaders
• consult with and influence senior management at various levels
• advise and make recommendations to business leaders on key strategic decisions
• provide support for financial, sales and operation reporting and analysis
• lead change and execute on business objectives

Director, Cost of Care Strategy

Account Manager

• Plays a pivotal role in ensuring optimal engagement of community-based providers
• Reporting to the Chief Business Development Officer, this position requires a strategic mindset, exceptional leadership skills
• Responsible for developing, executing, and tracking initiatives aimed at enhancing community-based provider engagement
• Develop and direct the execution of key strategic initiatives to support local and developing markets
• Lead relationship with national community-based provider associations
• Leverage our size and scale to produce strategies and solutions based on partnership
• Develop strategies, processes and tools that drive higher levels of engagement
• Provide expert advice on RFP writing and strategy around community-based providers
• Collaborate with health plan leaders to facilitate system-wide implementations
• Partner with local market and health equity teams to ensure providers achieve high-quality results
• Analyze industry trends and new emerging areas in community-based health
• Prepare meaningful, actionable reports and develop routine communication of status
• Collaborate with operational areas and appropriate vendors on initiatives

Vice President, Community-Based Partnerships

Cloud Engineer

• Plans and oversees the configuration of software and infrastructure services on the cloud platform
• Manages cloud infrastructure as code
• Automates deployment and administration
• Ensures security of cloud components
• Collaborates with the DevOps team to manage and lead upgrades, enhancements, and software migrations
• Develops and executes code-based CI/CD deployment plans for new and existing infrastructure
• Develops and implements monitoring solutions for cloud environments
• Builds and maintains capacity plans
• Develops and implements technical efforts for cloud applications
• Delivers continuous integration and delivery pipeline and standards

Senior Cloud Platform Engineer

Business Analyst

• Perform various analysis and interpretation to link business needs and objectives for assigned function
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations
• Identify ways to enhance performance management and operational reports related to new business implementation processes
• Coordinate with various business units and departments in the development and delivery of training programs
• Develop, share, and incorporate organizational best practices into business applications
• Diagnose problems and identify opportunities for process redesign and improvement
• Formulate and update departmental policies and procedures
• Serve as the subject matter expert on the assigned function product to ensure operational performance

Capacity Planning Business Analyst III

• Directs the design of population health strategy initiatives and programs
• Improves care coordination and health and quality outcomes
• Oversees the effectiveness of care and develops process improvements
• Leads population health strategy team on performance, improvement, and career growth path considerations
• Works cross functionally to drive process improvements
• Complies with all policies and standards

Director, Population Health Strategy

• Assists business stakeholders in driving a demand generation plan
• Ensures all demand for approved projects is gathered and managed efficiently
• Provides demand forecasts to leadership
• Analyzes demand data to identify and report on trends
• Collaborates with requirements stakeholders to develop business case analysis of projects

IT Demand Analyst II

Manager

• Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder.
• Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome.
• May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources.
• Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders.
• Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members.
• Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs.
• Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services.
• Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
• Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs.
• Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
• Performs other duties as assigned. Complies with all policies and standards.

Behavioral Health Care Manager

Affiliate Manager

• Create and scale enterprise talent and capability programs with a primary focus on skills enablement, workforce readiness, and internal mobility.
• Support the implementation, governance, and continuous improvement of enterprise skills frameworks, taxonomies, and capability models.
• Translate workforce and skills data into actionable insights that inform talent decisions, capability development, and strategic workforce priorities.
• Establish and manage the skills analytics and reporting layer, including ingestion, visualization, governance, and interpretation of skills data from external vendors and internal systems.
• Present strategy and process to multiple levels of the organization, including senior leadership.
• Continuously enhance our tools, resources, and capabilities to drive industry-leading practices.
• Continually solicit feedback and evaluate processes and programs to proactively drive improvements.
• Establish relationships across the organization to bring in diverse perspectives and drive the utilization and adoption of talent processes.
• Develop the appropriate change management approaches to enable organizational adoption.
• Partner with People Business Solutions team to embed our tools and frameworks into our HCM and allow that system to drive insights, focused on skills data and insights.
• Partner with HR analytics, People Systems, and vendors to ensure skills data is accessible, trusted, governed, and actionable.
• Develop and maintain visual insights and summaries (e.g., dashboards, executive-ready materials) to communicate program impact and trends.
• Facilitate cross-functional working sessions and validations forums to align skills, capabilities, and program direction.
• Research best practices and trends, including methodologies and technology enhancements, and make recommendations to continuously improve our offerings.
• Manage vendor relationships to ensure adherence to SOWs and proper organization utilization of services and solutions.
• Create and deliver polished presentation materials and resources for deployment across the organization.

Talent and Capability Partner – Skills Enablement

QA Engineer

• Lead monitoring teams in Member and Provider Services (MPS)
• Focus contact center quality program on outcomes and statistical significance
• Oversee systems and processes to alleviate service quality issues
• Collaborate cross-functionally to define and improve service quality
• Review key performance indicator (KPI) metrics
• Develop strategy for onboarding, hiring, and training new employees

Director, Quality Assurance

Auditor

• Lead medical record audits, monitor and analyze clinical documentation, and modify business processes to measure member outcomes
• Assess provider performance and quality of care through clinical case reviews
• Lead clinical audits for provider medical records both remotely via electronic medical records and on site to assess performance, determine trends and compile written reports summarizing findings, including clinical recommendations to assure the delivery of quality services
• Lead case reviews to assess the clinical performance provided in the provider network, including written clinical summaries and recommendations
• Perform ongoing quantitative and statistical analysis of the business unit’s performance data to include various contracted performance measures, service utilization and member/provider complaint and quality of care trends
• Coordinate with internal teams to assure audit requests are fully understood, accurately compiled and delivered timely
• Perform other performance and process improvement activities
• Performs other duties as assigned
• Complies with all policies and standards

Quality Improvement Auditor – Clinical

• Responsible for creation of member contract documents, including Evidence of Coverage (EOC) and related documents, for commercial products for high risk states
• Independently performs regulatory and operational research related to EOC and benefit development
• Conducts risk assessments, including impact to member contract documentation and downstream output
• Monitors pending legislation and regulations affecting Centene's commercial product in high risk states
• Provides updates to relevant member contract documents and provides the business with recommended changes
• Performs detailed language analysis of the Ambetter/Commercial Evidence of Coverage (EOC) and other relevant member materials
• Ensures quality control, compliance with State and Federal regulations as well as organizational standards
• Leads initiatives related to these activities
• Drafts and creates alternative language to include in regulatory member materials
• Conducts research projects to provide guidance on legal, contractual and regulatory requirements for assigned states
• Seeks to resolve member contract documentation issues which may negatively impact service to members
• Serves as a Subject Matter Expert within depth knowledge of health insurance products, procedures, and regulations
• Analyzes pending legislation and regulations affecting Centene’s commercial product related to member materials
• Provides recommendations to the business regarding changes needed to member contractual documents
• Performs risk assessment of member contractual materials related to passed and proposed legislation in high risk states
• Assists in developing junior employees and maintains/updates training materials
• Leads updates and maintenance of Policies and Procedures, Work Plans and any department training materials
• Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market
• Creates, drafts, and revises filing documentation, including but not limited Evidence of Coverage and regulatory checklists
• Facilitates EOC review meetings with impacted departments to discuss recommended EOC revisions and language
• Reviews include multiple phases of research, drafting and coordinating of internal approvals
• Develops and presents communications with alternative viewpoints
• Builds persuasive arguments and secures cooperation of others
• Determines the appropriate approach to problem solving
• Analyzes and creates appropriate responses to questions from regulators related to filing documentation

Development Analyst III

Account Executive

• Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company's policies and programs
• 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, help facilitate the continuance of health insurance, and offer assistance with recertification
• Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product
• Understand and apply all policies and procedures pertaining to: Disclosures and provisions of the Advantage Medicare product, enrollment and disenrollment
• Develop a presence in the local community to help generate enrollments
• 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
• Understand the covered benefits, non-covered benefits, exclusions and exemptions
• Assist members in accessing health care, transportation needs and other services or issues as they occur and pertain to members
• Keep informed and adhere to current information pertaining to marketing activity guidelines set forth by various regulatory agencies—this includes providing enrollees with all corresponding materials and documentation
• Keep alert to competitive products and marketing practices, and to keep management informed concerning them
• 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
• Submit special reports regarding the operation of the territory, acceptance or rejection of products, and competitive conditions beneficial to other Marketing representatives and company operations
• Performs other duties as assigned
• Complies with all policies and standards

Medicare Sales Representative

• Responsible for providing auditing and tracking support to the MeridianCare Sales Leadership Team
• Oversight and responsibility of auditing all member, prospective member and agent interactions with call center staff
• Conducts weekly production evaluations for assigned agents
• Participates in QA calibrations, audit meetings, and team huddles
• Submit Quality Resolution Plans (QRPs) for assigned agents and sales leadership
• Audit all inbound and outbound communications with members, prospective members and agents
• Assist with QA newsletter and FAQ tracker updates
• Create and present reporting based on auditing trends and findings
• Ensure new hire readiness for agents and QA staff through quality audits and training
• Performs other duties as assigned
• Complies with all policies and standards

Sales Auditor, Bilingual

• Taking inbound telephone inquiries and web inquiries from prospective members
• Placing outbound calls to prospective members in response to leads received
• Conducting sales presentations over the telephone that may result in telephonic enrollments, in-home appointments, seminar reservations, or a kit request with follow up call
• Handling web inquiries and responding through outbound calls or email
• Presenting plan options to callers to encourage prospective members to join a plan
• Following up on leads by conducting outbound calls designed to encourage prospective members to join and existing members to remain with the plan
• Referring leads to outside sales representatives for in-home appointments and enrollment meetings
• Ordering pre-sale materials and distributing leads to outside sales representatives via lead tracking system, SFDC (SalesForceDotCom)
• Qualifying prospects and attempting to close the sale
• Following scripts for inbound calls, outbound calls, and telephonic enrollments
• Remains up-to-date and familiar with competitor’s health insurance plans and industry trends
• Focus on production and keeps up with team goals