Centene Corporation

Systems Engineer

• Drives the collaboration with business and IT stakeholders to translate complex business requirements into comprehensive functional and non-functional technical specifications, ensuring alignment with strategic goals and solution design.
• Gathers and validates business / technology requirements to establish scope and parameters of requirements and define project impact, outcome criteria, and metrics
• Analyzes and verifies requirements for completeness, consistency, comprehensibility, feasibility, and conformity to standards
• Translates conceptual user requirements into functional requirements in a clear manner that is comprehensible to developers / project team
• Creates systems and business process models, specifications, diagrams, and charts to provide direction to developers and/or the project team
• Interprets user requirements into feasible options and communicate these back to the business stakeholders
• Manages and tracks the status of requirements throughout the project lifecycle; enforce and redefine as necessary
• Communicates changes, enhancements, and modifications of business requirements to project managers, sponsors, and other stakeholders so that issues and solutions are understood
• Plans and coordinates user acceptance testing (UAT)
• Monitors and review levels of IT services specified in the service-level agreements (SLAs) with the business
• Research, reviews, and analyzes the effectiveness and efficiency of existing requirement gathering processes and develop strategies for enhancing or further leveraging these processes; quantify potential efficiency opportunities and track accordingly
• Maintains system protocols by writing and updating procedures
• Provides references for users by writing and maintaining user documentation; provide help desk support; train users
• Prepares technical reports by collecting, analyzing, and summarizing information and trends
• Involved in clarifying requirements and implementing solutions that meet the business needs
• Documents business requirements and potential solutions for system functionality and reporting needs
• Performs other duties as assigned
• Complies with all policies and standards

Senior Business Systems Analyst

Claims Specialist

• Ensure timely processing of complex pending medical claims
• Verify and update information on the submitted claims
• Review work processes to determine reimbursement eligibility
• Process first time claims with added complexity
• Communicate with stakeholders important information needed for successful processing
• Maintain appropriate records, files, documentation, etc.
• Meet and maintain department production and quality standards
• Performs other duties as assigned

Claims Analyst II

Analyst

• Analyzes and reviews the contact center's workload to build resourcing and optimize scheduling plans to meet business objectives and goals
• Analyzes the effectiveness and complex results of the contact center's schedule and provides scheduling methodology improvements
• Participates in and leads meetings with stakeholders to analyze staffing plans and performance
• Works closely with management and other stakeholders to understand staffing requirements
• Deploys analytical techniques to create optimized schedules that balances business needs with employee preferences
• Analyzes contact center patterns, including volumes, trends, and contact center productivities
• Mentors and supports other members of the workforce scheduling team
• Advises on using a centralized vs. decentralized queue strategy and evaluates how this strategy will impact key performance metrics
• Ensures accurate records of contact center staff schedules
• Influences changes in policies and procedures for the workforce management unit

Senior Workforce Scheduling Analyst

Medical Director

• Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit
• Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities
• Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making
• Supports effective implementation of performance improvement initiatives for capitated providers
• Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members
• Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements
• Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership
• Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes
• Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
• Participates in provider network development and new market expansion as appropriate
• Assists in the development and implementation of physician education with respect to clinical issues and policies
• Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components
• Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care
• Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality
• Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment
• Develops alliances with the provider community through the development and implementation of the medical management programs
• Represents the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues
• Represents the business unit at appropriate state committees and other ad hoc committees
• May be required to work weekends and holidays in support of business operations, as needed

Designer

• Design and implement instructional strategies that support learning and performance within functional teams
• Lead meetings with stakeholders to understand business requirements, develop learning strategies to meet said requirements and lead development processes
• Create and implement learning, virtual simulations and assessments on approved platforms in online environment
• Outline and deliver timely training project plans
• Oversee maintenance of training resources and support sites
• Develop instruments to assess individual change in knowledge, skills and quality results
• Conduct reviews of training program objectives assessing the need for modifications to content and structure
• Research current industry trends, recommend and incorporate related updates into the standard curriculum
• Facilitate training as needed to support operational goals

Senior Curriculum Designer

Manager

• Serve as the direct people leader for multiple teams responsible for Provider Enrollment, Auditing, and Provider Data Management & Updates.
• Manage, coach, and develop staff through performance management, training, and career development.
• Establish staffing models, productivity expectations, and cross ‑ functional alignment to support business and regulatory needs.
• Update and maintain training materials, policies, and standard operating procedures to ensure consistent execution across teams.
• Provide operational ownership and oversight of the health plan’s entire Provider Enrollment lifecycle , including initial enrollment, revalidation, updates, and terminations.
• Oversee provider enrollment auditing activities to ensure compliance with state, federal, NCQA, CMS, and contractual requirements.
• Provide oversight and governance of the Centene Corporate credentialing process , ensuring alignment, issue escalation, and audit readiness at the health plan level.
• Partner with internal and external stakeholders to resolve enrollment, credentialing, and data discrepancies.
• Ensure the timely and accurate processing of provider data updates (adds, changes, and terminations) across all systems.
• Develop and maintain data integrity through audits, controls, reporting, and root ‑ cause analysis.
• Establish and monitor KPIs and operational goals for Provider Enrollment and Provider Data Management functions.
• Manage encounter response files and error correction processes related to provider data.
• Lead provider data and enrollment audit preparation and execution, including internal, state, federal, and accreditation audits.
• Track audit findings, corrective action plans, and ongoing monitoring activities.
• Schedule and oversee monthly provider verifications related to enrollment specifications and demographic changes, particularly for designated specialty types.
• Responsible for systems implementation, enhancements, and process improvements related to provider enrollment and data management.
• Coordinate materials and provider data support for Requests for Applications (RFAs) , new business, and expansions.
• Collaborate with internal business partners to support enterprise initiatives and regulatory changes

Manager, Provider Data Management

Security Engineer

• Lead the Privacy & Security Enterprise Engagement Officers (EEO) Shared Services Team
• Collaborate with other Shared Services across the organization with a focus on EPSRM
• Support the Enterprise Engagement Officer team
• Build trusted partnerships with Health Plan leadership and key enterprise stakeholders
• Align staffing and resources to shared service and line of business complexity
• Ensure the team’s alignment with defined goals
• Direct and oversee the team’s ongoing efforts to serve as a subject-matter-expert for privacy, security and AI requirements
• Provide Executive-ready updates for Health Plan and EPSRM leadership
• Meet with regulators or other state representatives to answer questions
• Maintain a centralized requirements & deliverables register or pipeline mapping obligations to owners
• Ensure adequacy of control validation evidence

Director, Privacy & Security, Enterprise Engagement

• Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit
• Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities
• Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services
• Supports effective implementation of performance improvement initiatives for capitated providers
• Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members
• Conduct regular rounds to assess and coordinate care for high-risk patients
• Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
• Participates in provider network development and new market expansion as appropriate.
• Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.

• Manages day to day operations of the Security Issues Management team
• Provides people leadership, workload prioritization, and operational oversight
• Ensures remediation efforts align with enterprise risk tolerance, regulatory expectations, and recognized cybersecurity frameworks
• Leads and oversees the end-to-end lifecycle of security issues management
• Partners with Internal Audit, Compliance, Legal, Privacy, Technology Risk, and technical teams to coordinate remediation activities
• Develops, matures, and continuously improves processes, documentation, and automation

Manager, Security Issues Management

Clinical Operations

• Plan, develop, and drive execution of medical management and quality improvement programs
• Oversee corporate accreditation, quality improvement, medical management operations and new business development and implementation
• Define medical management and quality improvement strategic and operating plans
• Collaborate to evaluate medical trends and develop medical management and quality improvement initiatives
• Develop and implement business plans to leverage technology to increase effectiveness and efficiency
• Develop and implement standardized training, auditing, and work processes

Vice President, Population Health – Clinical Operations

Public Relations

• Oversee the development and implementation of media strategies and public relations plans
• Promote local, regional and national awareness of Centene’s policies, values, and mission
• Develop and implement media and public relations strategies
• Represent Centene at media and public events
• Oversee the development of target media lists, proposals for news stories, and coordinate media interviews and speaking opportunities with company executives
• Analyze the reporting of industry and competitive news that impact the organization, its subsidiaries and/or the industry and recommend action plans
• Build and maintain relationships with key media partners and continuously grow the positive reputation of the corporation
• Work closely with CCO to develop and execute high-quality media programs from conception to execution to placement

Director, Media & Public Relations

Compliance

• Develops and implements strategies to ensure successful maintenance and implementation of compliance and risk programs that meet regulatory requirements for assigned products across the enterprise
• Champions cross-functional collaboration by working closely with Risk & Compliance teams, business units, legal, IT, and operational leaders
• Leads the documentation of processes and controls
• Oversees the review and periodic update of compliance process documentation
• Coordinates with the GRC Administration team, Compliance Systems & Reporting
• Serves as the principal liaison between business/process stakeholders and technology teams
• Architects and implements governance structures for the GRC application
• Designs and maintains robust standards and criteria for business cases submitted to the governance committee
• Leads efforts to ensure the accuracy and currency of field values within the GRC application
• Develops a framework to evaluate and interpret data outputs and reporting

Director, Risk & Compliance Processes – Initiatives

Account Manager

• Acts as the Account Director for various programs and provides leadership, strategic direction and oversight of the account managers in the Account Management team
• Collaborates with internal operations and clinical teams to develop and execute best practices, promote client solutions and satisfaction, and develop and deploy on-going training for account managers
• Serve as a subject matter expert and oversee all pharmacy program implementations, client relationship management, Quarterly Business Reviews and client strategies
• Develop skills and capabilities of Account Managers including analytical problem solving, client relationship management, program implementation excellence, trend management, formulary and rebate management
• Develops tools and processes to enhance the clinical program management and relationship management capabilities of the Account Management team which include reporting, specialty trend management, rebate management and quarterly business reviews
• Oversee escalated client issues unresolved by the Account Managers and follow-up with appropriate solutions
• Review and provide feedback on Request for Proposal responses related to programs, trend management, account management and long-term strategy management
• Analyze data to support client meetings and presentations and lead client presentations
• Performs other duties as assigned. Complies with all policies and standards.

Senior Manager, Account Management – Specialty Pharmacy

• Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members
• Evaluates the needs of the member via phone or in-home visits related to the resources available
• Develops ongoing care plans for members with high level acuity
• Facilitates care coordination and collaborates with appropriate providers or specialists
• Monitors care plans/service plans and/or member status and outcomes for changes
• Collects, documents, and maintains member information and care management activities
• Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits
• Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members

Care Manager

Account Executive

• Represent the company to all prospective and existing clients
• Monitor client satisfaction and recommend changes to enhance satisfaction
• Perform sales and marketing related activities on company programs and products, including infusion services, medical supplies, respiratory supplies, and retail pharmacy services
• Serve as the contact for client issues and inquiries and collaborate with various departments on resolutions ensuring clients needs are met
• Develop and maintain relationships with various levels of clients utilizing current network for additional accounts
• Monitor client satisfaction and recommend appropriate strategies, tactics, and operational initiatives to continuously enhance client satisfaction
• Attend patient care conferences and professional in-services to ensure continuance of new products and strategies
• Assist with account renewals, contract negotiations and intake referral process

Senior Business Systems Analyst

Claims Analyst II

Senior Workforce Scheduling Analyst

Medical Director

Senior Curriculum Designer

Manager, Provider Data Management

Director, Privacy & Security, Enterprise Engagement

Medical Director

Manager, Security Issues Management

Vice President, Population Health – Clinical Operations

Director, Media & Public Relations

Director, Risk & Compliance Processes – Initiatives

Senior Manager, Account Management – Specialty Pharmacy

Care Manager

Account Executive II – Specialty Pharmacy