Centene Corporation

Financial Planning and Analysis

• Compile and analyze financial information for the company
• Lead various financial projects
• Partner closely with business and finance leadership to deliver insightful analysis
• Develop measures to track, trend and forecast related impacts of organizational strategic initiatives
• Run pre-established reports as well as development of new reports for internal stakeholders
• Develop metrics to evaluate financial impact of proposed contracts
• Contribute commentary/insights into the business units performance based on area specific knowledge and analysis based results/indicators
• Create and analyze monthly, quarterly, and annual reports and ensures financial information has been recorded accurately
• Perform financial forecasting and reconciliation of internal accounts
• Identify and research variances
• Handle complex and high level financial analysis
• Present and discuss analysis with upper management
• Lead forecasting and budgeting processes, including quarterly forecast submissions, maintenance of a rolling forecast, and assumption-based budget planning with scenario and sensitivity analysis
• Partner closely with adjacent finance and accounting teams to support month-end close
• Lead month-end financial reporting, delivering clear variance analysis, key trends, and actionable insights versus forecast and budget to VP-level stakeholders
• Drive financial and operational analysis through reporting, forecasting support, demand/capacity modeling, workforce metrics, and data-driven insights that inform business decisions
• Provide financial oversight for technology investments and workforce decisions, ensuring alignment with budgets, forecasts, and procurement policies
• Facilitate financial support for new technology purchases, ensuring compliance with financial and procurement policies, validating financial impact and budget alignment
• Partner with BTS (Centene's Business Technology Solutions) and operational leaders to support strategic initiatives, drive informed decision-making, and maintain financial transparency

Finance Analyst IV – IT Finance

Pharmacist

• Deliver rapid quality and process improvement information to the technicians on their team
• Prepare material for and deliver in team meetings
• Serve as a subject matter expert for their team
• Provide guidance to pharmacy technicians on quality assurance monitoring and productivity standards
• Track and triage coverage determination requests submitted from providers
• Obtain verbal authorizations and request detailed clinical information from prescribers
• Approve coverage determination requests based on defined criteria
• Document coverage determination request decision into the PBM system and notify providers and/or members
• Respond to client inquiries regarding authorization approvals and PBM on-line applications
• Refer coverage determination requests for specialty drugs to delegated vendor or client for processing
• Perform other duties as assigned

Lead Pharmacy Technician

Operations

• Ensure administration of the pharmacy program is accurate and compliant by supporting various operational tasks
• Perform duties to support the development, coordination and maintenance of the pharmacy program
• Review benefit/formulary setup and testing (new and year over year)
• Conduct claims analysis
• Perform other duties as assigned
• Comply with all policies and standards

Pharmacy Operations Coordinator

Support Engineer

• Translate Medicare Advantage and Medicaid Risk Adjustment business requirements into production-ready technical solutions
• Support Encounter RA Prioritization and Encounter RA Chart Process
• Analyze provided requirements, procedures, and data needs to automate processing and improve existing business systems
• Support production-ready SAS code for Encounter Risk Adjustment workflows
• Create multi-user, real-time, robust database solutions by integrating healthcare datasets
• Provide business and technical expertise in requirements solicitation, system analysis, technical design, programming and documentation of business applications
• Monitor and report on the status of departmental projects and implement corrective actions

Senior Business Technical Analyst

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
• Shape Value-Based Care (VBC) strategies, vendor arrangements, and contract design
• Collaborate with internal partners to ensure VBC strategies are analytically sound and operationally feasible
• Research and identify new business opportunities
• Work with Medicare/marketplace and Medicaid teams to assess impact of program/policy changes
• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes
• Oversee health plan experience, identify trends and recommend improvements
• Lead the development of sophisticated financial models to assess financial risk and opportunity

Manager, Actuarial Services

• Conduct analysis, pricing and risk assessment to estimate financial outcomes
• Manage health plan specific actuarial needs and produce actuarial reports
• Serve as the main point of contact for all actuarial related activities for an assigned contract
• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes
• Research and analyze the impact from legislative changes
• Analyze various data reports, identify trends and gaps and recommend action

Associate Actuary

• Plans and directs all aspects of the company's operational policies, objectives, and initiatives
• Develops policies and procedures for operational processes in order to ensure optimization and compliance with established standards and regulations
• Represents the organization in its relationships with major customers, suppliers, competitors, commercial and investment bankers, government agencies, professional societies, and similar groups
• Develops a sound short-and long-range plan for the organization
• Ensures the adequacy and soundness of the organization’s financial structure and reviews projections of working capital requirements
• Negotiates and otherwise arranges for any outside financing that may be indicated

President & CEO

General

• Supports community connection activities including connecting members to community resources
• Provides members with known community resources and supports the care team
• Assists members to connect them to known community and care resources
• Promotes awareness of care/services and supports all member related correspondence
• Documents and maintains community resources to ensure standards of practice
• Provides assistance to the clinical team and conducts non-clinical general health assessments
• Conducts both telephonic and/or in-person outreach to locate individuals and families
• Performs other duties as assigned

Community Resource Coordinator II

Manager

• Develops, assesses and coordinates holistic care management activities
• Evaluates member service needs and develops care plans/service plans
• Acts as liaison and member advocate between member/family and healthcare providers
• Performs frequent home and/or site visits to assess member needs
• Provides education to long-term care members and their families on various topics
• Ensures appropriate referrals based on individual member needs
• Maintains accurate documentation in electronic care management system
• Ensures compliance with clinical guidelines and state/federal guidelines

LTSS Service Care Manager – Behavioral Health

Clinician

• Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and NCQA standards
• Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal
• Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards
• Communicates with members, providers, facilities, and other departments regarding appeals requests
• Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards
• Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeals requests
• Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices
• Performs other duties as assigned
• Complies with all policies and standards

Clinical Review Clinician – Appeals, Behavioral Health

Analytics Engineer

• design, build, and own scalable data pipelines that ingest external and internal data into Snowflake, including automation of file-based ingestion processes
• architect, develop, and maintain dbt transformation workflows to produce curated, production-ready data models and tables
• establish and enforce best practices for data modeling, performance optimization, data quality, and pipeline reliability across the platform
• develop and maintain Python- and SQL-based processes for data ingestion, validation, transformation, and monitoring
• lead the implementation and management of GitLab for version control, code collaboration, and CI/CD processes across the analytics team
• define and operationalize team standards for source control, code reviews, deployment workflows, and documentation
• build, optimize, and own Power BI datasets, semantic models, and reporting layers to support scalable analytics and decision-making
• partner with clinical, operational, and business stakeholders to translate data needs into technical solutions and communicate insights effectively
• mentor and train team members on data engineering workflows, Snowflake, dbt, GitLab, and Power BI to enable shared ownership and reduce single points of failure
• continuously improve platform architecture, tooling, and processes to support a scalable, maintainable, and modern analytics ecosystem
• support expansion of Snowflake capabilities (e.g., application layers or integrations) to enable advanced analytics and operational use cases
• contribute to advanced analytical initiatives, including identifying cost-savings opportunities and generating insights from complex healthcare datasets

Senior Analytics Engineer

Data Scientist

• Oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance
• Direct oversight for credentialing and re-credentialing of all physicians, mid-level practitioners and organizational providers
• Oversee all activities related to the management of provider data, including the development and management of training materials, policies, and procedures
• Ensure updates (adds, changes, and terminations) for new or existing provider records are made in accordance with health plan policies and state/federal regulations
• Ensure compliance with key performance indicators established by corporate office, NCQA credentialing standards, and state/federal requirements
• Manage updates to and production of hard copy and online provider directories
• Ensure accuracy of provider enrollment specifications and specialty types and demographics

Senior Manager, Credentialing & Provider Data Management

Security Engineer

• Lead development, monitoring, maintenance, and improvements of a foundational Security Governance pillar
• Plan and manage requirements and track completion of objectives for security risk, compliance and assessment
• Drive and execute initiatives involving cross-departmental dependencies
• Manage projects to improve and strengthen the enterprise security posture
• Maintain awareness of existing and proposed enterprise security policies and standards
• Provide support in security policy and standard development
• Identify regulatory changes that will affect information security policies, standards and procedures
• Lead the design, evaluation, and oversight of controls for key security and security IT projects, programs, applications, and systems

Senior Security Governance Program Manager – Secure Configuration, Asset Management

• Provides resource support to members and connects them to local resources for services
• Works with leadership to identify appropriate local resources based on needs
• Assists with connecting members to local resources and documentation
• Acts as a resource for members seeking support
• Monitors delivery of services and performs follow up
• Works with providers and community organizations to support members
• Develops education and training programs for care management staff
• Ensures resource services information is documented

Resource Specialist

Director

• Lead and direct process improvement activities that provide more efficient and streamlined workflow
• Responsible for leading and collaborating with others on NCQA Accreditation and/or HEDIS performance
• Responsible for quality improvement aspects of risk adjustment processes for all products
• Collaborate with Medicare STARS team to improve overall STARS ratings
• Oversee provider satisfaction surveys and implement action plans for improvements
• Research and incorporate best practices into operations
• Organize and control activities, methods, and procedures to achieve business objectives
• Review and implement new technological tools and processes
• Present results of improvement efforts and ongoing performance measures to senior management
• Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines