Centene Corporation

Manager

• Manage a team of RNs, Social Workers, and Support Staff
• Oversees care management issues related to members or providers
• Develops, implements, and oversees long-term care management policies
• Reviews long-term care management required documentation
• Manage escalated and complex care cases
• Ensures proper coordination and communication of medical service functions
• Sets goals and objectives for long-term care management team
• Monitors audits within care management for compliance

Manager, LTSS Clinical Care Management

Director

• Manage all aspects of pharmacy operations in two markets with multiple products
• Perform duties to develop, direct and implement a pharmacy benefit management program
• Aid in formulating and administering related organizational policies and procedures, including pharmacy service quality, pharmacy utilization management and achievement of Company goals for pharmacy and medical programs
• Establish the strategic vision, objectives and policies and procedures for the pharmacy program in support of the Corporate strategic vision for multiple plans and markets
• Plan, direct and implement pharmacy activities for multiple plans and products
• Act as the pharmacy contract administrator for the development and implementation of key contracts and ensure that relevant performance standards are met by vendors
• Participate in external accreditation initiatives for multiple plans and products
• Manage and analyze operating costs and participate in preparing materials needed for budget planning or special initiatives
• Generate, review and analyze drug utilization, utilization management, financial and other ad-hoc reports, records and directives
• Confer with staff to obtain data required for planning work function activities
• Review statistical analysis in support of recommendations and/or decision making for policies and operational procedures
• Maintain daily communication with plan management relative to each market and product
• Manage pharmacy department staff to assure adequate coverage and support in multiple locations and for multiple products
• Support provider education initiatives such as counter detailing and incentive programs in multiple markets

Senior Director, Pharmacy

• Manages the care management team of licensed physical and/or behavioral health clinicians that serve long-term care members with physical/medical health needs and/or behavioral/mental health needs to develop and assess high quality, cost-effective healthcare outcomes
• Manages escalations and care management issues related to members or providers
• Oversees and reviews long-term care management required documentation to maintain compliance with federal and state regulations and contractual agreements
• Develops, implements, and oversees long-term care management policies and procedures within the long-term care management team based on regulatory requirements and industry standards
• Assigns, monitors and evaluates work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs
• Directs the daily activities of long-term care management staff including reviewing and approving the caseloads based on state requirements, care management staff experience, and member needs
• Manages escalated and complex care cases, and provides guidance to long-term care team members to address member concerns related to physical/medical health and/or mental/behavioral health needs
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
• Ensures proper coordination and communication of medical service functions with other departmental functions at the business as assigned
• Develops, implements, and oversees long-term care management programs to facilitate the use of appropriate services and resources
• Sets goals and objectives for long-term care management team to achieve cost-effective healthcare results
• Monitors audits within care management to ensure compliance with regulatory requirements for federal, state, and National Committee for Quality Assurance (NCQA) standards, as required
• Works with long-term care management senior management to provide updates and insights on care management team goals
• Reviews long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
• Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care
• Educates and provides resources for long-term care management team on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers
• Assists long-term care management senior leadership with onboarding, hiring, and training long-term care management team members
• Leads and champions change within scope of responsibility
• Performs other duties as assigned

Data Analyst

• Integrates, conforms, profiles and maps data
• Provides quality assurance oversight on business processes
• Optimizes data efficiency and quality
• Resolves data quality problems and collaborates with the business
• Interprets and analyzes data from multiple sources
• Develops, executes, maintains, and troubleshoots scripts and reports
• Presents data-driven insights and recommendations to stakeholders

IT Data Analyst II, SQL

• Manages the investigation and resolves security incidents
• Recommends enhancements to improve security
• Identifies common attack patterns to publicly exposed aspects of the organization's environment
• Contributes to the implementation of scalable and preventative security measures
• Executes enterprise-wide Incident Response Plan
• Partners with business units to accomplish enterprise-wide remediation
• Develops and delivers presentations to senior leadership team
• Manages day-to-day operations of the Cybersecurity Incident Response Team (CSIRT)
• Recommends process improvements
• Manages the hiring and training of new and existing staff
• Conducts performance reviews
• Provides leadership, technical guidance and coaching
• Shares knowledge and develops staff capabilities

Senior Manager, Incident Response

Business Operations

• provide strategic guidance and operational support for process improvement initiatives within the Duals program
• focus on end-to-end process mapping, identifying gaps and opportunities
• assist in the development and implementation of process enhancements to optimize operational workflows
• collaborate across multiple functional areas to ensure process integrity and drive measurable improvements

Senior Business Process Consultant

Product Manager

• guiding the strategic direction for a portfolio of technologies within a defined Domain space
• product strategy, roadmap, opportunity identification, business case development, industry research, and new product or feature introduction
• end-to-end product governance from concept to production
• aligning and engaging stakeholders to manage and measure the delivery of product strategy and roadmap against established goals
• developing, maintaining, and publishing the long-term strategy of a defined Domain space
• supporting both enterprise and technology strategies and be interlocked with other domains
• evaluating and publishing the health and security risk, life-cycle stage, and technology cost of a defined Domain space
• collaborating with senior leadership and technology teams to negotiate and agree on proposed new systems and changes to existing systems and practices
• identifying business opportunities / needs
• bridging the gap between the business clients' need and technology solutions to realize value
• facilitating demand shaping with business and architecture
• driving a sustainable cyclical process of business value identification, financial review, forecasting, idea generation, opportunity sizing, business case preparation, and product enablement
• synthesizing market changes and technology modernization into actionable improvements for products
• measuring the performance of a defined Domain space to assess efficiencies gained, value realized and ROI of product investments
• arbitrating portfolio impacts and delivery commitments for new or modified priorities
• reviewing and influencing user stories and milestones to guide Agile and Scrum teams to deliver consistently and inline with product roadmaps

Enterprise Platforms Product Manager

• Responsible for analytical data needs
• Handle complex data requests, reports, and predictive data modeling
• Analyze health management programs including: data collection, validation and outcome measurement
• Financial, pharmacy, claims, provider, and member data
• IRS, CMS, HHSC, HEDIS reporting
• Internal data cleansing and data reconciliation analysis
• Trend analysis in various functional areas of health care management
• Create and generate reports through MS-Excel, MS-Access, and SQL using Business Objects interface and direct links to core databases (ODS/EDW)
• Produce reports for and interface with senior management and internal and external stakeholders
• Gather and interpret business requirements and monitor data trends to proactively identify issues
• Execute data changes and update core systems as needed
• Handle multiple projects and timelines effectively and communicate risks and issues to manager regularly
• Assist with training lower level Data Analysts
• Performs other duties as assigned.
• Complies with all policies and standards.

Data Analyst II – HEDIS

• Responsible for analytical data needs
• Handle complex data requests, reports, and predictive data modeling
• Analyze health management programs including data collection, validation and outcome measurement
• Gather and interpret business requirements and monitor data trends to proactively identify issues
• Execute data changes and update core systems as needed
• Handle multiple projects and timelines effectively and communicate risks and issues to manager regularly
• Assist with training lower level Data Analysts

Data Analyst II, SQL, Power-BI

Account Executive

• Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company's policies and programs.
• Provide greater access to health insurance, by providing education and assistance to Medicare individuals.
• Distribute health education materials and arrange for health screenings.
• Provide Facilitated Enrollment, help facilitate the continuance of health insurance, and offer assistance with recertification.
• Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product.
• Conduct home visits and personalized appointments as needed to complete the enrollment process.

Medicare Sales Representative

Strategy

• Develop and direct strategic business initiatives within product offerings
• Ensure subject matter expertise is infused into all products
• Identify and support the integration of duplicative products/interventions across all business units
• Ensure consistent and seamless integration of adaptive technology and expert team-based services across all product portfolios
• Support sales and client services across all business units with product customization
• Support in the financial analysis of product performance

Senior Director, Strategic Initiatives, Medicare

• Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company's policies and programs.
• Provide greater access to health insurance, by providing education and assistance to Medicare individuals.
• Distribute health education materials and arrange for health screenings.
• Provide Facilitated Enrollment, help facilitate the continuance of health insurance, and offer assistance with recertification.
• Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product.
• Understand and apply all policies and procedures pertaining to: Disclosures and provisions of the Advantage Medicare product, Enrollment and Disenrollment.
• Develop a presence in the local community to help generate enrollments.
• Conduct home visits and personalized appointments as needed to complete the enrollment process.
• Market Advantage on-site at hospitals, senior centers, assisted living facilities, community events and other sites as designated.
• Understand the covered benefits, non-covered benefits, exclusions and exemptions.
• Assist members in accessing health care, transportation needs and other services or issues as they occur and pertain to members.
• Keep informed and adhere to current information pertaining to marketing activity guidelines set forth by various regulatory agencies—this includes providing enrollees with all corresponding materials and documentation.
• Keep alert to competitive products and marketing practices, and to keep management informed concerning them.
• Conduct and participate in telemarketing/outreach efforts as required.
• Attend and participate in sales meetings, training programs, conventions, and special events.
• Complete applications in a timely and accurate manner.
• Submit special reports regarding the operation of the territory, acceptance or rejection of products, and competitive conditions beneficial to other Marketing representatives and company operations.
• Performs other duties as assigned.
• Complies with all policies and standards.

• Oversee and manage the community relations and marketing functions of the health plan in accordance with government and contractual guidelines and the mission, philosophy and objectives of Centene and the health plan
• Manage the development and execution of local strategies to enhance the Health Plan’s visibility in the community by developing high profile outreach activities and events, with a focus on grass-roots efforts for Medicaid consumers
• Ensure effective integration of major, service area-wide community relations programs and strategies with local programs, initiatives and partnerships, responsible for maximizing the local impact of the health plan
• Review and analyze reports, records and directives, and confer with staff to obtain data required for planning work function activities, such as new projects, status of work in progress, and problems encountered
• Actively solicit across the health plan from all inside disciplines ideas to improve growth and member retention and branding of all product lines
• Oversee and coordinate the marketing and community relations staff’s work flow and communicate established performance standards
• Develop and ensure compliance with departmental objectives that are consistent with the health plan and corporate objectives

Senior Director, Community Relations

Operations

• Lead and direct process improvement initiatives by utilizing process improvement methodologies
• Manage the end-to-end NCQA audit timeline and ensure successful audit performance
• Oversee the administration, coordination and evaluation of quality assurance and training
• Direct the execution of performance improvement projects, including process mapping and process design
• Create and maintain dashboards, communications, and strategies to improve effectiveness
• Research and develop best practices, policies, procedures, and goals in compliance with guidelines
• Oversee data analysis and gathering processes to establish costs and benefits of process effectiveness
• Ensure compliance with URAC and Joint Commission Accreditation standards
• Review and implement new technological tools and processes
• Establish strong collaborative relationships with all functional units and their leaders

Director, Quality – Process Improvement

Compliance

• Assist in maintaining Centene Corporation's Compliance Program
• Guide special projects
• Provide regulatory interpretation
• Perform compliance reporting
• Develop and implement compliance auditing and monitoring strategies
• Respond to external requests for information required by the organization for its regulatory filings
• Respond to inquiries from state and federal regulatory agencies
• Monitor pending legislation and regulations affecting Centene Corporation services
• Maintain database and other reference materials related to legislative and regulatory issues and compliance
• Communicate state and federal requirements to internal and external clients
• Provide development guidance and assists in the identification, implementation, and maintenance of compliance policies, procedures and work instructions
• Assist in the identification, analysis, and resolution of compliance issues
• Maintain and reviews regulatory documentation necessary to maintain corporate standards
• Assist in developing, producing and conducting compliance training programs
• Perform periodic compliance audits, risk assessments and conducts related 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
• Plan, direct and coordinate the implementation of Compliance Committee policy to ensure decisions are properly executed
• Serve as a company wide resource and liaison on policies, contract issues and provisions, communications, workflow, and quality improvements initiatives
• Performs other duties as assigned
• Complies with all policies and standards

Manager, LTSS Clinical Care Management

Senior Director, Pharmacy

Manager, LTSS Clinical Care Management

IT Data Analyst II, SQL

Senior Manager, Incident Response

Senior Business Process Consultant

Enterprise Platforms Product Manager

Data Analyst II – HEDIS

Data Analyst II, SQL, Power-BI

Medicare Sales Representative

Senior Director, Strategic Initiatives, Medicare

Medicare Sales Representative

Senior Director, Community Relations

Director, Quality – Process Improvement

Compliance Analyst – Marketplace