Centene Corporation

Data Analyst

• Drive the execution of analytics strategy through the discovery, development, and implementation of leading-edge analytics that answer important business questions
• Align talent and resources to support enterprise and health plan needs by leveraging data to achieve strategic objectives and improve business performance
• Lead the planning and execution of enterprise-wide analytics projects and strategic initiatives, translating business goals into actionable solutions
• Lead development efforts as a liaison with business and technical partners, including managing stakeholder expectations, requirements gathering, testing, deployment and user adoption
• Prioritize team work, manage customer expectations and relationships, and maintain alignment of deliverables with business needs and strategic objectives
• Serve as a strategic domain contact as well as point of escalation and accountability to ensure customer partnership and satisfaction
• Partner cross-functionally at all levels of the organization and 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
• Lead cross-team project collaboration between state-based health plans and business units, including IT, Finance, Network Development, and Payment Integrity
• Mentor, manage, and ensure the continuous development of a team of analysts

Senior Manager, Healthcare Analytics

Operations

• Oversee operations, and business strategy utilizing cross-functional departments to meet strategic objectives
• Develop and manage methodologies for tracking, identifying and problem-solving issues, interpreting and presenting program results and insights, and developing data-driven analysis approach for clients
• Perform data analysis from a variety of data sources to evolve the metrics used to measure effectiveness and return on investment of all current and new product activity
• Collaborate with staff to identify internal and external customers and their expectations, initiate process changes to increase quality, decrease costs and improve staff, provider and member satisfaction
• Facilitate and support operations staff in the planning, achievement, and tracking of the organizations key strategic initiatives to create a positive impact on organizational scorecard
• Serve as an internal resource and advisor on improvement activities
• Explore new approaches to work processes by utilizing quality improvement techniques to eliminate waste and re-work
• Able to travel up to 25%

Operations Manager

Business Operations

• Support the Availity enterprise strategy by coordinating initiatives and aligning stakeholders
• Evaluate and optimize the Availity portfolio’s capabilities by quantifying performance and business value
• Identify, develop, and execute process improvement opportunities utilizing continuous improvement principles and LEAN/Six Sigma methodologies
• Drive adoption of solutions that improve efficiency, provider experience, and operational outcomes across multiple business functions
• Monitor process improvement projects and facilitate cross functional process improvement project teams ensuring deadlines and objectives are met

Senior Business Process Improvement Manager

Security Engineer

• Lead, coach, and develop a team of LRAs who support EEOs in delivering consistent, high‑quality deliverables across assigned areas
• Allocate and prioritize work across the analyst team based on market complexity, volume, and key regulatory and business cycles
• Oversee onboarding, training, and ongoing skills development for the analyst team
• Establish and maintain standard operating procedures (SOPs), templates, and playbooks for analyst activities
• Provide ongoing coaching, feedback, and performance input
• Support EEOs in tracking obligations, risks, and decisions related to privacy, security, AI governance, and business continuity
• Coordinate preparation of “Executive‑ready” briefing materials, dashboards, and summaries for EEOs and EPSRM leadership
• Maintain centralized, analyst‑managed requirement and deliverable inventories
• Direct analyst activities to identify and document privacy, security, AI governance, and operational resilience requirements
• Oversee analyst support of key EPSRM engagement deliverables
• Drive continuous improvement in analyst methods, reporting, skills set and tooling to increase efficiency, quality, and consistency of EPSRM engagement activities

Senior Manager, Privacy & Security Regulatory Engagement

Actuary

• conduct analysis, pricing and risk assessment to estimate financial outcomes
• manage health plan specific actuarial needs and produce actuarial reports
• develop Medicaid forecasts across multiple markets
• build strong technical skills and develop direct exposure to senior leadership and key stakeholders
• collaborate cross-functionally by sharing knowledge, supporting joint initiatives, and building strong working relationships

Associate Actuary – Medicaid

• Conduct analysis, pricing and risk assessment to estimate financial outcomes in support of the enterprise’s highest-priority Value-Based Care (VBC) initiatives
• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes
• Support methodology development and refinement of valuation approaches used to measure program efficacy and shared savings
• Extract, clean, and analyze complex claims and clinical datasets to stand up valuation models end-to-end
• Ensure cash reserves and liabilities enable payment of future benefits
• Determines equitable basis for distributing money for insurance benefits
• Participate in merger and acquisition analysis
• Performs other duties as assigned
• Complies with all policies and standards

• Responsible for analytic data needs of the business unit
• Handle complex data projects and act as a lead/resource for other Data Analysts
• Support claims audit execution through sampling, executive reporting, QA/reconciliation, Power BI/dashboard support
• Extract, transform, reconcile, and validate large healthcare claims datasets
• Develop and maintain recurring reports, dashboards, and analytical deliverables using SQL, Power BI, Excel
• Partner with audit, data analytics, IT, and business stakeholders

Data Analyst III

General

• Supports the prior authorization request to ensure all authorization requests are addressed properly and in the contractual timeline
• Aids utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access
• Supports authorization requests for services in accordance with the insurance prior authorization list
• Supports and performs data entry to maintain and update authorization requests into utilization management system
• Assists utilization management team with ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
• Contributes to the authorization review process by documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
• Remains up-to-date on healthcare, authorization processes, policies and procedures
• Performs other duties as assigned
• Complies with all policies and standards

Authorization Specialist I

• Partners with either Health Plans or Shared Services to translate privacy, security, artificial intelligence (AI), business continuity, and related requirements from client contracts, laws, and regulations into actionable enterprise controls
• Builds trusted relationships with Health Plan leadership and key stakeholders to ensure contract assurance, readiness reviews, Request for proposal (RFP) support, timely deliverable fulfillment, compliance reporting, and continuous improvement
• Drives early engagement with Enterprise Privacy, Security and Risk Management (EPSRM) visibility and influence across the organization
• Lead EPSRM engagement with Health Plans or Shared Services to ensure privacy, security, AI, and business continuity requirements are clearly understood, implemented, and monitored
• Interpret and translate regulatory, contractual, and legal requirements into operational controls and guide stakeholders on compliance expectations
• Validate and manage compliance evidence, deliverables, and audit readiness, including responses to regulators, clients, and internal/external auditors
• Build and maintain strong relationships with leadership, operational teams, and regulators to remove obstacles, resolve issues, and support consistent compliance practices
• Track regulatory, legislative and contract changes, assess organizational impact, and communicate required actions while supporting scalable control updates
• Oversee the accuracy and completeness of privacy, security, AI, and business continuity documentation, including plans, attestations, questionnaires, and related submissions
• Enhance enterprise engagement processes by driving standardized procedures, governance practices, templates, and continuous improvement efforts
• Support new market entries, RFP responses, contract renewals, and business expansion by providing specialized EPSRM subject matter expertise
• Identify risks and control gaps, recommend mitigation strategies, and contribute to improved compliance maturity across the enterprise.
• Performs other duties as assigned. Complies with all policies and standards.

Privacy & Security Engagement Officer

• Partners with either Health Plans or Shared Services to translate privacy, security, artificial intelligence (AI), business continuity, and related requirements
• Builds trusted relationships with Health Plan leadership and key stakeholders to ensure contract assurance
• Drives early engagement with Enterprise Privacy, Security and Risk Management visibility and influence across the organization
• Interpret and translate regulatory, contractual, and legal requirements into operational controls and guide stakeholders on compliance expectations.
• Validate and manage compliance evidence, deliverables, and audit readiness.
• Build and maintain strong relationships with leadership, operational teams, and regulators to remove obstacles, resolve issues, and support consistent compliance practices
• Support new market entries, RFP responses, contract renewals, and business expansion by providing specialized EPSRM subject‐matter expertise.
• Identify risks and control gaps, recommend mitigation strategies, and contribute to improved compliance maturity across the enterprise.

Privacy & Security Enterprise Engagement Officer

Vice President

• Oversee the product development function, including formulating product vision and strategy
• Define future product needs and enhancements
• Drive the creation of profitable, highly engaging, easy-to-use products across all business units
• Lead enterprise UM portfolio strategy and governance
• Partner with clinical technology vendors and product development partners
• Align roadmap priorities and enforce SLA accountability
• Drive end-to-end delivery across prior authorization, concurrent review, and clinical correspondence workflows
• Drive deployment of AI-enabled and other Tech capabilities across the UM lifecycle
• Establish operational effectiveness frameworks that measure productivity, accuracy, and throughput gains
• Own the enterprise ROI and KPI measurement framework for UM technology investments
• Develop and oversee the model for managing product development strategy
• Develop and oversee product roadmap in alignment with strategic goals, market trends, competitive landscape, client, and consumer needs
• Drive clinical, digital and data/analytics product innovation

Vice President, Clinical Technology - Portfolio Management

• Perform medical necessity reviews and authorization determinations to ensure members receive appropriate, high-quality behavioral health services
• Performs a clinical review and assesses care related to mental health and substance abuse
• Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate
• Evaluates member’s treatment for mental health and substance abuse before, during, and after services
• Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
• Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning
• Analyzes BH member data to improve quality and appropriate utilization of services
• Provides education to providers members and their families regarding BH utilization process
• Interacts with BH healthcare providers as appropriate to discuss level of care and/or services
• Engages with medical directors and leadership to improve the quality and efficiency of care
• Formulates and presents cases in staffing and integrated rounds
• Performs other duties as assigned and complies with all policies and standards.

Utilization Review Clinician – Behavioral Health

Program Manager

• Responsible for leading enterprise‑wide Prior Authorization (PA) governance and optimization efforts
• Lead large‑scale, cross‑functional PA governance initiatives
• Oversee all aspects of PA program planning, management, and execution
• Drive the enterprise‑wide PA optimization cycle to plan
• Ensure ad‑hoc PA requests are appropriately triaged, prioritized, and executed
• Drive large‑scale initiatives by coordinating the work of project managers and business analysts
• Create and maintain comprehensive timelines, workplans, and deliverables
• Identify implementation risks early and partner with functional leaders to develop mitigation plans
• Develop and maintain executive‑level dashboards and reporting
• Prepare concise, decision‑ready materials for Program Steering Committees and Executive Leadership
• Partner with PHCO Analytics to monitor post‑implementation impact
• Track utilization or spend anomalies following go live
• Proactively manage program‑level risks, dependencies, forecasts, and interdependencies
• Serve as the first point of escalation for PA program issues and risks
• Align stakeholders around data‑based prioritization, PA governance standards, and enterprise decision frameworks
• Create and deliver best‑practice guidance and training

Program Manager – PA Governance, Optimization

Project Manager

• Plan, organize, monitor, and oversee complex projects utilizing cross functional teams
• Assist in training and perform duties as the Lead Project Manager
• Support VP level initiatives and accountable for end to end execution
• Provide concise, executive ready status updates and decision support materials
• Ensure adherence to enterprise project management standards and reporting requirements

Project Manager IV

• Conduct analysis, pricing and risk assessment to estimate financial outcomes
• Manage health plan specific actuarial needs
• Produce actuarial reports to aid in developing corporate strategy
• Serve as the main point of contact for actuarial related forecasting activities
• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes
• Develop probability tables based on analysis of statistical data
• Research and analyze the impact from legislative changes
• Assess cash reserves and liabilities enable payment of future benefits
• Analyze various data reports, identify trends and gaps and recommend action
• Determine the equitable basis for distributing money for insurance benefits
• Create and update actuarial reports