Centene Corporation

Risk

• Supports the Senior Director in driving the strategy, execution, and ongoing enhancement of the organization's third-party risk management program.
• Helps translate the strategic vision into operational plans, overseeing key components of due diligence, risk assessments, compliance monitoring, and performance evaluation across the third-party lifecycle.
• Leads issue management activities, supports cross-functional initiatives that strengthen risk transparency, and ensures adherence to regulatory, contractual, and accreditation requirements.
• Contributes to executive-level reporting, supports internal and external audits, optimizes program operations, and develops team members to advance a culture of accountability and continuous improvement.
• Assists with defining the strategic vision, operating model, and organizational roadmap for the third party risk management program, ensuring alignment with enterprise priorities and regulatory and accreditation obligations.
• Leads the development, execution, and continuous refinement of a comprehensive third party risk management framework, a risk-based annual audit plan that adapts to emerging risks and changes within third party operations.
• Evaluate third party compliance and performance by conducting preservice, annual, risk based audits, and monitoring activities.
• Oversees the full lifecycle of due diligence, compliance monitoring, and performance assessment of third parties, ensuring alignment with contractual, regulatory, and accreditation requirements.
• Drives operational effectiveness by optimizing program resources and strengthening workforce capabilities.
• Leads development and delivery of executive level reporting and dashboards with insights for senior leadership and the board.

Director, Third Party Risk Management

Compliance

• Lead a team within Compliance Corrections responsible for the remediation and reporting activities
• Support the internal and external corrective action plan lifecycle and related reporting
• Partner with Product Compliance teams, Shared Services leadership, and market leaders
• Oversee the execution and continuous improvement of the Corrections Compliance program
• Provide regular updates on program performance to senior management and key stakeholders
• Recruit, supervise, and develop team members
• Identify and recommend strategic improvements that significantly impact organizational goals and performance
• Respond to inquiries from internal stakeholders and leadership regarding compliance matters
• Offer expert guidance to departments on non-compliance issues
• Influence management to enhance performance and support leadership in achieving organizational objectives
• Foster trusted, collaborative relationships with leadership
• Serve as the designated point of contact in the absence of the Senior Director of Compliance Corrections

Senior Manager, Enterprise Compliance Corrections

• Responsible for leading and managing the most complex, sensitive, and high-impact internal investigations across the organization
• Serves as a strategic advisor and subject matter expert on investigative best practices, regulatory compliance, and risk mitigation
• Consults with management, in-house counsel, and/or the Director of Corporate Compliance as needed to resolve difficult, highly sensitive or complex compliance issues
• Independently evaluates and assesses allegations to determine whether domestic laws, regulatory policies, or internal policies, procedures, and standards have been violated
• Plans, scopes, and conducts complex, confidential internal investigations from inception to conclusion
• Conducts, manages, and documents interviews with witnesses, as required for investigatory purposes
• Reviews investigation reports prepared by junior investigators
• Identifies risks, interprets investigation results, and recommends and communicates remedial actions to mitigate future potential risks
• Performs follow up to ensure remedial / disciplinary measures are implemented appropriately and timely
• Maintains meticulous case files and chronologies in accordance with best practices
• Prepares clear and concise draft investigation plans and reports
• Provides support and guidance to junior investigation staff as applicable
• Communicates directly with Federal or State regulators
• Supports the development and maintenance of Corporate Compliance policies and procedures and workflows

Corporate Ethics and Compliance Investigator

Manager

• Develops, assesses, and facilitates complex care management activities for mental and behavioral health needs members
• Evaluates the needs of the member via phone or in-home visits
• Develops ongoing care plans for members with high level acuity
• Coordinates between the member and/or family/caregivers, community resources, and the care provider team
• Monitors care plans/service plans and/or member status and outcomes
• Facilitates care coordination and collaborates with appropriate providers or specialists
• Provides education to members and their families
• Complies with all policies and standards

Care Manager, Behavioral Health

Security Engineer

• Oversees network security engineers
• Monitoring and confirming the performance of the network security systems
• Ensure appropriate levels of network security controls are managed within the organization
• Work alongside other internal teams and external vendors for compliance
• Guide and coach the network security team
• Lead an Innovation, Research & Advanced Development (IRAD) organization
• Drive forward-looking research while ensuring delivery of production-ready solutions
• Favor automation over manual processes to reduce risk and improve scale and reliability
• Leverage AI heavily to accelerate research and development
• Create an environment encouraging curiosity and experimentation
• Build trust with stakeholders by delivering safe, scalable, predictable solutions

Manager, Network Security Engineering

• Supports Centene's advocacy strategy through direct lobbying of federal policymakers in collaboration with patient and professional organizations.
• Builds and maintains relationships with key Members of Congress, Congressional Committees, Caucuses and Congressional staff.
• Engage in federal lobbying activities with Members of Congress, Congressional Committees, Congressional staff, federal agencies and other health-related organizations.
• Represent Centene’s priorities and position in forums led by our trade associations or strategic partners.
• Collaborate with Policy and core business colleagues to ensure alignment on key priorities.
• Represents Centene at congressional fundraisers which can require attendance at early morning, evening and weekend events.
• Educate and inform internal Centene audiences about the congressional process, legislation, and political issues that impact relevant business lines through written and oral presentations.
• Demonstrate strong attention to detail through written communication that delivers concise and accurate information for internal and external audiences.

Senior Government Affairs Manager

• Assist in maintaining Centene Corporation’s Compliance Program with a primary focus on external audit and regulatory exam coordination
• Serve as the lead coordinator and primary contact for external auditors and regulatory agencies for assigned external audits, examinations, and reviews
• Manage end‑to‑end external audit coordination, including audit intake, kickoff, evidence collection, quality review, submission, interviews, and closure
• Respond to and manage external requests for information related to regulatory audits, exams, and formal reviews
• Coordinate and support auditor and regulator interactions, including entrance conferences, onsite/virtual reviews, follow-up requests, and exit conferences
• Review draft audit reports, support rebuttal development, and coordinate responses, as applicable
• Communicate state and federal regulatory requirements related to external audits and examinations to internal stakeholders
• Maintain and manage audit and regulatory documentation in accordance with enterprise standards and regulatory expectations
• Assist health plans in managing relationships with regulatory agencies by ensuring consistent, accurate, and timely audit responses
• Serve as a company-wide compliance and external audit subject matter resource across markets, and functions

Senior Compliance Analyst – External Audit

Medical Director

• Assist the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing functions
• Provides medical leadership for utilization management, cost containment, and medical quality improvement activities
• Performs medical review activities pertaining to utilization review, quality assurance, and complex medical services
• Supports effective implementation of performance improvement initiatives for capitated providers
• Assists in planning and establishing goals and policies to improve quality and cost-effectiveness of care
• Provides medical expertise in operation of approved quality improvement and utilization management programs
• Assists in the functioning of physician committees
• Conducts regular rounds to assess and coordinate care for high-risk patients
• Collaborates with clinical teams, network providers, and medical consultants for reviewing complex cases
• Participates in provider network development and market expansion
• Develops and implements physician education with respect to clinical issues

Medical Director, Appeals

Public Relations

• Oversee the development and implementation of media strategies and public relations plans for the Wellcare and Medicare businesses
• Engage and educate external audiences on Centene’s mission, vision, goals, and progress
• Promote local, regional, and national awareness of Centene’s policies, values, and priorities
• 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
• Develop and communicate Centene’s strategic goals and tactical responses
• Ensure the media distribution of press clippings are timely and efficient

Senior Director, Media & Public Relations

• Responsible for advancing Centene’s reputation and strategic interests
• Manages multiple priorities with minimal oversight
• Influences key stakeholders internally and externally
• Builds and maintains strong relationships with media outlets
• Develops and executes integrated media and public relations strategies
• Provides strategic counsel and guidance to subsidiaries and senior executives
• Monitors and analyzes media coverage and legislative developments
• Acts as a key liaison with trade associations and external stakeholders
• Supports government relations initiatives with clear messaging
• Coordinates media interviews and speaking opportunities
• Manages Public Relations approval process between subsidiaries and corporate management
• Collaborates with Corporate Communications, Government Affairs, Legal, Compliance, and Policy teams

Public Relations – Media Manager

Financial Planning and Analysis

• Direct, negotiate and handle activities of the business units finance, accounting and analysis functions
• Responsible for leading the G&A function
• Oversee the preparation of accurate and timely financial reports ensuring requirements are met
• Lead G&A function
• Interpret financial reports for management team
• Review, communicate, and present strategic plans, operating budgets and forecasts
• Provide financial plan for performance variances, operating alternatives, program and investment initiatives
• Monitor and analyze business processes and systems to ensure data and system integrity
• Determine targets and measures ensuring alignment with business unit and corporate objectives, evaluate effectiveness and recommend updates as needed
• Serve as the point of contact for corporate and business unit functions regarding financial matters
• Direct support activities and timely information related to sales and account management to drive profitability
• Ensure optimization and accurate reporting of various financial related matters

Senior Director, Finance

• Develop and execute regulatory plans for complex projects including new projects and maintenance of licenses and reaccreditation for existing and new business opportunities
• Manage contracts and track performance to contractual requirements, provide consultation to other departments on requirements and escalate gaps as necessary
• Develop procedures and reports to monitor contractually required deliverables, including but not limited to, regulatory reports and performance metrics
• Review complex laws and regulations and provide guidance to other departments to ensure processes are in compliance
• Conduct HIPAA compliance audits and provide summary of outcomes and recommendations for improvement
• Perform gap analysis to current contract requirements and policies/procedures and offer recommendations to close gaps
• Monitor applicable regulatory requirements to ensure compliance with company and external standards
• Communicate with regulators as needed to seek clarification on contract requirements, regulations, processes or documents submitted for approval

Manager, Regulatory Affairs

Insurance

• Obtain and verify complete insurance information, including the prior authorization process, copay assistance and coordination of benefits.
• Assist with managing the work load to ensure that referrals and orders are handled in a timely manner
• Monitor each queue through various reports and redistribute work as appropriate
• Serve as the point of contact for key physicians’ offices and coordinate referrals with the sales team during insurance verification process
• Serve as the point of contact or designated rep for contracted payors
• Serve as the point of contact or designated rep for special pharma accounts working with their HUB’s and collecting and documenting pharma •specific data in the system
• Obtain and verify insurance eligibility for services provided and document complete information in system
• Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies
• Collect any clinical information such as lab values, diagnosis codes, etc.
• Determine patient’s financial responsibilities as stated by insurance
• Configure coordination of benefits information on every referral
• Ensure assignment of benefits are obtained and on file for Medicare claims
• Bill insurance companies for therapies provided
• Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures
• Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs
• Handle inbound calls from patients, physician offices, and/or insurance companies
• Performs other duties as assigned
• Complies with all policies and standards

Lead Intake & Insurance Verification Coordinator

Vice President

• Direct the provider network and contracting activities
• Lead all aspects of provider network strategy including, access analysis, network operations
• Support decision makers with analysis related to reimbursement and unit cost management
• Oversee the coordination and negotiation for the contracting department
• Establish the department’s strategic vision, objectives, and policies and procedures
• Develop, implement and maintain production and quality standards for the Contracting department
• Oversee network development staff and external consultants in the development of provider networks across expansion markets
• Perform periodic analyses of the provider network from a cost, coverage, and growth perspective
• Provide leadership in evaluating opportunities to expand or change the network to meet Company goals
• Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts
• Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations
• Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy
• Support market expansion and M&A activities by leading provider contract analysis related to due diligence
• Assist health plan CEO and/or COO vendors in key provider relations and strategy
• Ability to travel

Vice President, Network Development – Contracting

• Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends/schemes
• Monitor business processes and systems to assure integrity and compliance in billing and claims payment
• Lead teams of analysts to appropriately investigate all possible fraud, waste and abuse referrals
• Develop customized fraud plans to meet contract and federal requirements
• Develop educational materials to identify/validate waste activities as requested by the health plan and on an ad-hoc basis
• Respond to RFP request and implement new policies per contractual obligation
• Attend state/federal meetings as required by specific contracts
• Prepare/present the FWA program to state/federal personnel upon request, specifically during readiness reviews, and immediately following the go live or upon state agency personnel changes
• Review post-payment cases with appropriate parties to obtain refund
• Prepare and distribute monthly and quarterly saving reports