Centene Corporation

Manager

• Drives the execution of analytics strategy through the discovery, development, and implementation of leading-edge analytics that answer important business questions.
• Aligns talent and resources to support enterprise and health plan needs by leveraging data to achieve strategic objectives and improve business performance.
• Leads the planning and execution of enterprise-wide analytics projects and strategic initiatives, translating business goals into actionable solutions.
• Manages development efforts as a liaison with business and technical partners, including managing stakeholder expectations, requirements gathering, testing, deployment and user adoption.
• Prioritizes team work, manages customer expectations and relationships, and maintains alignment of deliverables with business needs and strategic objectives.
• Supports customer engagement and satisfaction by maintaining effective communication and transparency of work and deliverables with core stakeholders.
• Partners cross-functionally at all levels of the organization and communicate findings and insights to non-technical business partners.
• Independently engages with business leaders to understand market-specific levers and constraints.
• Leverages enterprise reporting tools to rapidly deliver data-driven insights and recommendations.
• Facilitates cross-team project collaboration between state-based health plans and business units, including IT, Finance, Network Development, and Payment Integrity.
• Mentors, manages, and ensures the continuous development of team.

Manager, Healthcare Analytics

• Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes
• Evaluates the needs of the member via phone or in-home visits related to the resources available
• Recommends and/or facilitates the care plan/service plan for the best outcome
• May perform telephonic, digital, home and/or other site visits outreach to assess member needs
• Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care
• Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms
• Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services

Care Manager, Behavioral Health

Bilingual

• Retaining current membership in assigned territory
• Conducting telephonic and field outreach including community events
• Assisting with Fidelis Care products
• Ensuring compliance with regulatory and corporate policies
• Developing and maintaining relationships with existing members
• Documenting all interactions in the appropriate system

Bilingual Retention Field Representative

Compliance

• Provide strategic leadership and oversight for the health plan compliance program, including compliance governance, regulatory strategy, policy development, and cross-functional implementation.
• Ensure accurate and timely execution and regulatory deliverables across business and operational areas.
• Lead the design, execution, and ongoing effectiveness of the market compliance program in alignment with enterprise standards and regulatory expectations.
• Oversee compliance with CMS Medicare requirements including SNP related obligations, and ensure timely submission of all applicable regulatory filings and deliverables.
• Serve as senior compliance leader and single point of contact for state interactions, compliance meetings and market level escalations.
• Serve as senior leadership in all Department of Insurance, Medicaid agency, and other regulatory audit activities applicable to New Hampshire market.
• Collaborate with Corporate Enterprise Risk Management and market leaders to identify, assess, document, and reduce compliance and business risks.
• Oversee internal compliance auditing and monitoring activities, direct corrective action planning, and hold business owners accountable for timely remediation and sustained compliance.
• Provide oversight of delegated entities, vendors, and material subcontractors, including annual oversight performance monitoring and corrective action follow up.
• Chair or support market compliance committees and provide regular reporting to market and enterprise leadership regarding risks, trends and remediation activities.
• Lead, coach, and develop compliance team members, and establish clear priorities, accountabilities and performance expectations.
• For New Hampshire plan only additional responsibilities: Maintain and track contract documentation, Medicaid contract amendments, and various regulatory measures. Work with Operational Departments to ensure that policies, procedures, and processes are developed and modified to comply with state regulatory standards. Provide guidance to various departments with respect to regulatory and contract language. Develop strategic relationships with agencies within the New Hampshire Department of Human Services and other state regulatory policymakers with oversight responsibility for Managed Care organizations, Medicare and Medicaid initiatives. Identify, evaluate and analyze the impact of state regulatory changes and advise management concerning impact . Represent senior management at various state committees, meetings, and industry forums and other engagements relevant to compliance and regulatory strategy. Maintain deep knowledge of New Hampshire Medicaid and applicable state regulatory requirements. Complies with all policies and standards.

Compliance Officer

Therapist

• Performs clinical reviews of clinical therapy services and/or durable medical equipment to members based on service request assessments and provides clinical expertise based on practice standards.
• Works with senior management to identify ways to improve the review and execution of therapy services based on clinical reviews of service request assessments.
• Performs utilization reviews of service requests regarding specialty therapy services and/or durable medical equipment for members based on best practice and documentation standards by the national therapy associations and organizational policies.
• Provides recommendations for therapy determinations and refers members to care management, as appropriate, based on service request assessments.
• Works with Utilization and Care Management teams and healthcare providers to ensure members are receiving the appropriate care and treatment.
• Expands therapy specialty knowledge and works with senior management to identify areas of improvement with therapy services and/or durable medical equipment for members.
• Assists with providing education including developing clinical trainings, consultations, and guidance related to therapy authorizations and/or durable medical equipment.
• Provides feedback to leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies.
• Performs other duties as assigned. Complies with all policies and standards.

OT, PT, Speech Therapy – Utilization Review

Artificial Intelligence

🌐
Worldwide
❌ Jobs You've Hidden
⭐️ Saved Jobs
✅ Applied Jobs
✉️ Email Alerts
👤 Account
This job opening is no longer available.
Similar Jobs
Microsoft Alliance Director

🕒 March 24

Fireworks AI

51 - 200

🤖 Artificial Intelligence

☁️ SaaS

🏢 Enterprise

Website
LinkedIn
All Job Openings

Microsoft Alliance Director at Fireworks AI focusing on Azure partnerships. Leading go-to-market strategies and driving measurable revenue through strategic alliances.

🇺🇸 United States – Remote

🔥 Funding within the last year

💰 $230M Series C - Fireworks AI on 2025-10

⏰ Full Time

🔴 Lead

🤖 Artificial Intelligence

Director of AI – Computer Vision

🕒 March 24

SafelyYou

51 - 200

🤖 Artificial Intelligence

☁️ SaaS

🤝 B2B

Website
LinkedIn
All Job Openings

Director of AI at SafelyYou leading computer vision projects for senior living care. Responsible for managing AI systems and teams to improve care and safety outcomes.

🇺🇸 United States – Remote

💰 $43M Series C - Safely You on 2025-01

⏰ Full Time

🔴 Lead

🤖 Artificial Intelligence

Client Principal – AI Consulting, Property & Casualty Insurance

🕒 March 24

CloudFactory

1001 - 5000

🤖 Artificial Intelligence

☁️ SaaS

🏢 Enterprise

Website
LinkedIn
All Job Openings

Client Principal guiding AI transformation in the P&C insurance sector. Build senior relationships and lead consulting engagements for AI adoption and delivery oversight.

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

🤖 Artificial Intelligence

Director, Business Reporting, Advanced Analytics – AI

🕒 March 21

MasterBrand, Inc.

10,000+ employees

🛒 Retail

Website
LinkedIn
All Job Openings

Director of Business Reporting at MasterBrand Cabinets leading AI and analytics initiatives. Responsible for transforming data processes and implementing AI strategies across the enterprise.

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

🤖 Artificial Intelligence

Director of Generative AI Operations

🕒 March 20

Hugo

1001 - 5000

🤝 B2B

🤖 Artificial Intelligence

🌍 Social Impact

Website
LinkedIn
All Job Openings

Director of Generative AI Operations leading end-to-end delivery and scaling of AI services at Hugo. Focused on operational excellence in AI workflows for global enterprise clients in a fully remote setting.

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

🤖 Artificial Intelligence

🦅 H1B Visa Sponsor

Search More Artificial Intelligence Jobs
🌐
Worldwide
Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com
Search
Search Jobs by country
Search jobs by city
Search jobs by job title
Search entry-level jobs
Search junior-level jobs
Search senior-level jobs
Search jobs by tech stack
Search jobs by contract type
Search remote internships
Search remote part-time jobs
Remote jobs Anywhere in the World
Companies Hiring Anywhere in the World
Companies Hiring Sales People Anywhere in the World
Companies Hiring Software Engineers Anywhere in the World
Resources
Advice
Tips for finding remote jobs
Interview questions and answers
Resume examples
Cover letter examples
Post a job
Affiliates
Privacy policy
Terms of service
Job board SEO course
AI Apply Copilot
OpenClaw job finder
Jobs by Country
Remote jobs anywhere in the world (Worldwide remote jobs)
Remote jobs United States
Remote jobs Australia
Remote jobs Brazil
Remote jobs Canada
Remote jobs France
Remote jobs Ireland
Remote jobs Germany
Remote jobs Netherlands
Remote jobs Spain
Remote jobs UK
Popular Jobs
Remote data analyst jobs
Remote customer support jobs
Remote executive assistant jobs
Remote marketing jobs
Remote product designer jobs
Remote product manager jobs
Remote project manager jobs
Remote recruiter jobs
Remote sales jobs
Remote software engineer jobs
Jobs by Type
Remote full-time jobs
Remote part-time jobs
Remote contract jobs
Remote internship jobs
Remote entry-level jobs
Remote jobs with no experience required
Remote junior jobs (1-3 years of experience)
Digital nomad jobs
Remote jobs with no degree required
Freelance remote jobs
Temporary remote jobs
Remote jobs hiring now
Stay at home mom jobs

Director – AI Ethics and Governance

• Assist in maintaining Centene Corporation’s Compliance Program
• Provide regulatory interpretation
• Perform compliance reporting
• Lead special projects
• Develop and implement compliance auditing and monitoring strategies
• Respond to external requests for information required by the organization for its regulatory filings
• Manage compliance reporting responsibilities
• Respond to inquiries from state and federal regulatory agencies
• Communicate state and federal requirements to internal and external clients
• Assist in the identification, analysis, and resolution of compliance issues
• Maintain and review regulatory documentation necessary to maintain corporate standards
• Perform periodic compliance audits, risk assessments and conducts related to ongoing compliance monitoring activities
• Assist health plans in managing relationships with regulatory agencies and seek to resolve policy issues which may negatively impact service to members

Senior Compliance Analyst – External Audit

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

Auditor

• Develop, conduct, administer and analyze clinical training programs
• Conduct audits of clinical systems entry and/or processes
• Assist in development of audit tools
• Develop and conduct clinical education courses, including case management education and training for new employees
• Develop and maintain complex audit processes and audit tools related to authorizations, appeals, quality, case management
• Analyze training needs and identify, select or develop appropriate training programs including training aids and materials
• Audit staff in accordance with established auditing processes
• Train audit staff in the use of audit tools and identification of patterns or trends that require additional training or corrective action
• Evaluate effectiveness of training programs including cost/benefit analyses
• Research, analyze, and recommend internal/external training programs
• Maintain records of training activities and employee progress
• Assist with revisions to Policy and Procedure and/or work process development

Senior Clinical Trainer, Auditor – Registered Nurse

Risk

• Provides management support and strategic guidance and expertise to business case development for enterprise level initiatives across many functional areas
• Drives strategic recommendations for portfolio planning with an emphasis on proactive solutions
• Involved in team level development activities, such as training, mentoring, and tracking department metrics
• Mentors junior team members on duties and responsibilities with supervision from leadership
• Leads all levels of staff responsible for initiatives included in the company’s operating plan in order to support their success, development and effective completion and communication of their initiative
• Oversees the pipeline of business cases and prioritize them based on strategic value, interdependencies, risk appetite, and available capacity
• Ensures consistent methodology and rigor in business case development across all teams, providing quality assurance and coaching to Senior Business Process Consultants
• Ensures all approved business cases are transitioned to initiatives (both documentation and clear responsibilities for each initiative) and tracks ROI for launched projects and initiatives
• Leads engagement and communications with senior and executive stakeholders, translating business pain points into strategic recommendations and ensures successful execution towards plan
• Coordinates proactive collaboration across cross-functional teams to identify and proactively respond to stakeholder business problems
• Leads larger scale, cross-functional initiatives that are intended to drive performance improvement, financial gains, customer satisfaction and improved compliance
• Provides strategic and policy guidance on assigned initiatives so that all processes are considered for maximizing effective implementation and results
• Organizes work teams, drives consensus and ensures end to end policy/process integrity to accomplish project work

Senior Payment Integrity Specialist – Governance

• Leads business case development for proposed initiatives
• Supports the strategic planning process
• Ensures that initiatives support the strategic business plan
• Provides strategic and policy guidance on assigned initiatives
• Organizes work teams and drives consensus
• Performs detailed analysis of data, workflows, policies, and procedures
• Writes and delivers communication to all levels of organization

Payment Integrity Specialist – Governance

• Assesses, plans, implements, and coordinates holistic care management activities
• Develops or assists with developing personalized care plans/service plans for long-term care members
• Educates members and their families/caregivers on services and benefits available
• Assists with developing and continuously assessing ongoing long-term care plans
• Works to identify providers, specialists, and/or community resources needed
• Coordinates and manages appropriate services between the member and care provider team
• Monitors care plans/service plans, member status, and outcomes
• Provides recommendations to care plan/service plan based on identified member needs
• Identifies problems/barriers for long-term care management
• Provides resource support to members and their families/caregivers
• Reviews long-term care member data to identify trends
• Reviews referral information and intake assessments

Senior LTSS Service Care Manager

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
• As needed, may represent 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

National Medical Director

Program Manager

• The Program Manager V operates as a PMO/Director-level governance leader for a healthcare analytics organization.
• This role owns the analytics portfolio operating model—intake, prioritization, governance, standards, and executive reporting—ensuring analytics initiatives and data products deliver measurable value across medical cost, quality, risk adjustment, value-based care, and operational performance.
• The Program Manager V partners with clinical, finance, operations, and technology leaders to drive decisions on scope, funding, capacity, and sequencing; ensures appropriate controls for regulated healthcare data (including privacy and security); and provides functional leadership to program and project managers supporting analytics delivery.
• Owns PMO governance for the healthcare analytics portfolio (initiatives and data products), aligning demand to enterprise priorities across medical economics, clinical analytics, quality (e.g., HEDIS), risk adjustment, and value-based care.
• Designs and runs the analytics operating model: intake and triage, prioritization, stage gates, delivery standards, and decision rights; ensures consistent use across analytics teams and partners.
• Chairs/coordinates executive governance forums and portfolio reviews; drives timely decisions on scope, sequencing, funding, and resource trade-offs when analytics capacity is constrained.
• Establishes and enforces reporting standards (KPI definitions, objective and key results definitions, dependency and risk thresholds) and delivers executive-ready portfolio dashboards, narratives, and decision memos.
• Leads integrated planning across analytics workstreams (BI/reporting, data engineering, data governance, advanced analytics/ML, vendor feeds), including dependency mapping, release planning, and operational readiness.
• Drives quality and reliability controls for analytics outputs (data quality checks, reconciliation, lineage documentation, change management for metric definitions) to increase trust and reduce rework.
• Owns portfolio financial governance (budget planning, forecasting, vendor spend) and benefits realization (value hypotheses, adoption, and outcomes tracking) in partnership with finance and business sponsors.
• Provides functional leadership and mentorship to program/project managers and analysts supporting delivery, including coaching on governance rigor, stakeholder management, and execution discipline.
• Continuously improves PMO practices, tooling, and templates to mature analytics delivery (e.g., standard charters, requirements, validation plans, release notes, and post-implementation measurement).

Program Manager V – Healthcare Analytics

• Obtain and verify complete insurance information, including the prior authorization process
• 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
• Resolve claim rejections for eligibility, coverage, and other issues
• Performs other duties as assigned