Centene Corporation

Care Coordinator

• Support care management activities and assigned member teams
• Ensure services are delivered by healthcare providers and partners
• Perform member outreach by telephone and through home visits
• Document care/service plans and related activities
• Discuss care plans, next steps, resources, questions, concerns, and education with members
• Coordinate care activities with healthcare and community providers, partners, members, and caregivers
• Support member and provider inquiries, requests, and concerns
• Communicate with care managers, practitioners, and others to facilitate member services and continuity of care
• Support service assessments and screenings and document member care needs
• Maintain and distribute member records as needed
• Identify needs and make referrals to Care Managers, community-based organizations, and Disease Managers
• Provide education on available benefits and resources
• Perform other assigned duties and comply with policies and standards

Care Coordinator II

Project Manager

• Plan, organize, monitor, and oversee complex projects using cross-functional teams
• Manage the full project life cycle, including requirements gathering, project plans and schedules, resources, budget, execution, deployment, and closure
• Utilize corporate and industry-standard project management tools and techniques
• Assist with establishing and maintaining corporate project management methodology and department procedures
• Maintain project documentation, including meeting minutes, action items, issue lists, and risk management plans
• Lead communication of project status to stakeholders, including written executive summaries
• Negotiate with stakeholders to identify resources, resolve issues, and mitigate risks
• Coordinate cross-functional meetings to meet stakeholder expectations and company objectives
• Provide functional and technical knowledge across multiple business and technical areas
• Monitor project deliverables for quality standards, including design documents, test plans, training materials, and operations documentation

Project Manager III – Managed Care

Facilities Coordinator

• Support the People Leader in the day-to-day operation of the Facility
• Ensure a safe, comfortable, clean, and functional working environment
• Perform daily operational duties and specific project work
• Coordinate vendor activities
• Assist in repairs of facilities as needed
• Lead team through daily tasks
• Lead project management activities, including reconfiguring office space and partnering with vendors
• Answer product and service questions and resolve customer dissatisfaction issues related to site repair and maintenance
• Respond to customer calls/tickets and follow up to ensure resolution
• Coordinate failure analysis of equipment and facility utilization to recommend repairs and schedule maintenance
• Conduct physical counts and reconcile inventory data records to ensure secure storage of assets
• Maintain a library of resource materials, supplies, and equipment
• Lead building assessments for seating placement, cleanliness, repairs, and maintenance
• Oversee the CENTENE Safe Program for buildings within the portfolio

Facilities Coordinator II

Operations

• Identify and implement enterprise-wide process improvement activities using LEAN/Six Sigma, PDSA or similar methodologies
• Support business infrastructure and procurement of new business opportunities
• Develop, prioritize and execute performance improvement projects
• Assist with implementation and training of functional areas regarding process engineering maintenance plans and staff trainings
• Collect, monitor and evaluate project key performance metrics
• Develop project status reports
• Facilitate cross-functional improvement teams following the DMAIC roadmap or similar improvement process
• Communicate process design and implementation gaps to upper management
• Perform other duties as assigned
• Comply with all policies and standards

Process Improvement Specialist

Medical Director

• Assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities
• Perform medical review for utilization review, quality assurance, and complex, controversial, or experimental medical services
• Support performance improvement initiatives for capitated providers
• Help establish goals and policies to improve quality and cost-effectiveness of care and service
• Provide medical expertise for quality improvement and utilization management programs
• Assist with physician committee structure, processes, and membership
• Conduct regular rounds for high-risk patients and coordinate care with care management teams
• Collaborate with clinical teams, network providers, appeals teams, and medical and pharmacy consultants on complex cases and medical necessity appeals
• Participate in provider network development and new market expansion
• Develop and implement physician education on clinical issues and policies
• Identify utilization review studies, adverse utilization trends, unusual provider practice patterns, and benefit/payment adequacy issues
• Identify clinical quality improvement studies to reduce unwarranted variation in clinical practice
• Interface with physicians and providers to implement recommendations improving utilization and healthcare quality
• Review complex, controversial, unusual, or new-service claims for medical necessity and appropriate payment
• Develop provider-community alliances through medical management programs
• Represent the business unit before local and national publics, state committees, and ad hoc committees as needed

National Medical Director

Business Analyst

• 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
• Perform other duties as assigned
• Comply with all policies and standards

Business Analyst II

Program Manager

• Oversee HealthWorks agency performance
• Ensure compliance with HealthWorks Program Manual requirements, contract obligations, and DCFS standards
• Support business department initiatives, including requirements gathering, plan and schedule creation, resource management, and program execution and deployment
• Conduct quarterly desk reviews and agency audits
• Analyze audit results and provide coaching, training, and technical assistance
• Oversee programs using corporate and industry-standard tools and techniques
• Serve as primary liaison between YouthCare, DCFS, and HealthWorks agencies
• Facilitate quarterly agency meetings and operational discussions
• Coordinate cross-functional meetings to meet stakeholder expectations and business objectives
• Review monthly and quarterly performance reports
• Maintain business process documentation, including meeting minutes, action items, issue lists, and risk management plans
• Create and monitor department deliverables, including clinical reporting documents, reference materials, and policy and procedure documentation
• Develop and deliver training for HealthWorks agencies
• Communicate program status to management and key stakeholders
• Identify trends and opportunities to improve outcomes and compliance
• Identify resources, resolve issues, and mitigate risks
• Identify requirements, procedures, and problems to improve existing processes

Program Manager I

Manager

• Develop, assess, and facilitate complex care management activities for primarily physical-needs members
• Provide high-quality, cost-effective healthcare outcomes through personalized care plans and member/family education
• Evaluate member needs, access barriers, and social determinants of health
• Develop ongoing care/service plans and collaborate with providers, specialists, and community resources
• Identify care problems and barriers and provide care management interventions
• Coordinate members, families/caregivers, and care provider teams to ensure person-centered care
• Follow up and monitor member status, condition changes, and progress toward care plan goals
• Provide local resource support for services including employment, housing, independent living, justice, and foster care
• Facilitate timely access to needed care and services
• Conduct telephonic, digital, home, and/or other site outreach
• Collect, document, and maintain member information and care management activities for regulatory compliance
• Educate members and families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits
• Provide leadership feedback on opportunities to improve care quality and cost effectiveness
• Perform other duties as assigned and comply with all policies and standards

Care Manager, RN

• Promote increased program efficiency, service levels and value by capturing and monitoring performance
• Identify opportunities for operational improvement and regulatory compliance
• Develop strategies to realize improvement opportunities and align organizational priorities and resources
• Manage multiple concurrent projects through the full project life cycle
• Gather requirements and create project plans and schedules
• Obtain and manage project resources and budgets
• Facilitate project execution, deployment and closure
• Utilize project management tools and techniques
• Maintain detailed project documentation, action items, issues lists and risk mitigation plans
• Communicate project status to stakeholders through executive summaries and presentations
• Negotiate with stakeholders to secure resources, resolve issues and mitigate risks
• Lead cross-functional meetings
• Provide functional and technical knowledge regarding program requirements and operations

Program Manager III

• Support care management activities and assigned member teams to ensure provider/partner service delivery and continuity of care/member satisfaction
• Conduct member outreach by telephone and home visits
• Document care/service plans and related activities
• Discuss care plans, next steps, resources, questions, concerns, and ongoing education with members
• Coordinate care activities with healthcare and community providers, partners, members, and caregivers
• Respond to member and provider inquiries, requests, and concerns
• Communicate with care managers, practitioners, and others to facilitate member services
• Support service assessments and screenings and document member care needs
• Maintain member records according to state and regulatory requirements and distribute them to providers as needed
• Identify needs and make referrals to Care Managers, community-based organizations, and Disease Managers
• Provide education on available benefits and resources
• Travel approximately 30% throughout assigned Arkansas service areas to meet members, providers, caregivers, and community partners
• Perform other assigned duties and comply with all policies and standards

• Supports implemented Identity and Access Management systems, processes, standards, and solutions
• Provides advanced technical support and business knowledge to business areas through analysis and reporting
• Designs and programs complex new processes and reports for IAM systems
• Analyzes company functions, processes, and activities to improve computer-based business applications
• Adheres to and participates in auditing relevant security controls
• Manages the implementation and operations of IAM services
• Leads and manages the design and delivery of development experiences and programs
• Manages hiring and training of staff, conducts performance reviews, and provides leadership, technical guidance, and coaching
• Shares knowledge and develops staff capabilities
• Develops and communicates organizational objectives
• Inspires and motivates team members to achieve results
• Performs other assigned duties
• Complies with all policies and standards

Manager, IAM

Patient Care

• Work with members and providers to close care gaps and remove barriers to care
• Improve member and provider experience through outreach and face-to-face interaction
• Collaborate with providers in the field to improve HEDIS measures
• Educate provider practices on HEDIS measures and ICD-10/CPT coding
• Support quality improvement interventions and audits related to plan providers
• Assist in resolving deficiencies affecting compliance with State and Federal HEDIS standards
• Conduct telephonic outreach and health coaching to members
• Conduct face-to-face member and family education about care gaps and barriers to care
• Schedule doctor appointments for members and assist with preventive care access
• Arrange transportation, follow-up appointments, and connections to community-based resources and affinity programs
• Document all actions taken regarding member contact
• Serve as liaison and member advocate between members/families, physicians, facilities, and agencies
• Act as Centene/WellCare representative in the provider community
• Collaborate with Provider Relations and other departments, including customer service, to resolve issues and improve performance
• Refer members to case or disease management as appropriate
• Complete special assignments and other duties as assigned
• Comply with all policies and standards

Patient Care Advocate

• Work with members and providers to close care gaps and remove barriers to care
• Improve member and provider experience through outreach and face-to-face interaction
• Collaborate with providers in the field to improve HEDIS measures
• Educate providers on HEDIS measures and ICD-10/CPT coding in accordance with NCQA requirements
• Support quality improvement interventions and audits related to plan providers
• Resolve deficiencies affecting compliance with State and Federal HEDIS standards
• Conduct telephonic outreach and health coaching to members identified as needing preventive services
• Provide face-to-face education to members and families about care gaps and barriers to care
• Schedule doctor appointments and follow-up appointments for members
• Arrange transportation and connect members with community-based resources and affinity programs
• Act as liaison and member advocate between members/families, physicians, facilities, and agencies
• Serve as Centene/WellCare representative in the provider community
• Assess provider performance data and identify opportunities for improvement
• Collaborate with Provider Relations on Quality, Risk Adjustment, Operations, claims, and encounters
• Document all member contacts and actions taken
• Resolve member issues with other departments, including customer service
• Refer members to case or disease management as appropriate
• Complete special assignments and other duties as assigned
• Maintain confidentiality of business and protected health information
• Comply with all policies and standards

Data Analyst

• Provide advanced analytical support for business operations in areas including claims, provider data, member data, clinical data, HEDIS, pharmacy, and external reporting
• Extract, load, model, and reconcile large amounts of data across multiple system platforms and sources
• Review data to determine operational impacts and needed actions
• Elevate issues, trends, areas for improvement, and opportunities to management
• Develop reports and deliverables and make recommendations to management
• Model data using MS Excel, Access, SQL, and/or other data warehouse analytical tools
• Assist management in driving business decisions based on data
• Ensure compliance with federal and state deliverable reporting requirements through data quality audits and analysis
• Train and mentor other Data Analysts
• Assist with determining workload and related activities for other Data Analysts
• Perform other duties as assigned
• Comply with all policies and standards

Data Analyst IV

Supervisor

• Supervise community and resource coordination activities, including member outreach and connection to local resources
• Supervise day-to-day activities of community and resource coordination team members
• Assign tasks based on state and contractual requirements and member needs
• Collaborate with community/resource coordination and care management teams to ensure effective, appropriate member care
• Ensure compliance with state and regulatory guidelines and standards
• Educate and provide guidance and resources to address member requests and needs
• Evaluate team performance and provide feedback on performance, goals and career milestones
• Coach and guide the team to improve community resources, outreach services and member connections
• Assist with onboarding, hiring and training team members
• Perform other duties as assigned and comply with all policies and standards

Care Coordinator II

Project Manager III – Managed Care

Facilities Coordinator II

Process Improvement Specialist

National Medical Director

Business Analyst II

Program Manager I

Care Manager, RN

Program Manager III

Care Coordinator II

Manager, IAM

Patient Care Advocate

Patient Care Advocate

Data Analyst IV

Supervisor, Resource Coordination