Centene Corporation

Pharmacist

• Provide customer service-focused specialty pharmacy phone outreach, with phone work making up 90% of the shift
• Contact medical offices to clarify and enter prescriptions
• Contact patients to provide updates on prescription outcomes
• Support the Pharmacist callback queue by helping obtain refills and prescription clarifications
• Assist with pre-QA/data entry
• Respond to email escalations
• Stay current with required training
• Accurately prepare prescription orders in a timely manner under direct pharmacist supervision
• Interact with various departments to provide accurately dispensed prescriptions
• Perform prescription data entry functions by viewing images and entering prescription information into the system
• Prepare and submit prescription refill requests
• Initiate clarification requests and receive verbal instructions from prescribers as permitted by pharmacy regulations
• Complete reorder processing for timely filling of prescription refills
• Comply with safety, quality assurance, accreditation, legal, state and federal regulatory requirements, and company policies
• Complete work lists according to manager guidelines
• Perform other duties as assigned

Pharmacy Technician I – Specialty Outreach

Manager

• Support the Physical Health Care Management team
• Develop, assess, and facilitate complex care management activities for members with primarily physical health needs
• Evaluate member needs, barriers to appropriate care, and social determinants of health
• Develop ongoing care plans and service plans
• Collaborate with providers, specialists, and community resources to address unmet needs
• Identify problems and barriers to care and provide appropriate interventions
• Coordinate person-centered care among members, families, caregivers, and care provider teams
• Follow up and monitor member status, changes in condition, and progress toward care-plan goals
• Provide resource support for services such as employment, housing, independent living, justice, and foster care
• Facilitate care management and ensure timely access to needed care and services
• Conduct telephonic, digital, home, and other site outreach
• Collect, document, and maintain member information and care-management activities for regulatory compliance
• Educate members and families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits
• Provide leadership feedback on opportunities to improve care quality and cost-effectiveness
• Perform other assigned duties and comply with policies and standards

Care Manager, RN

Care Advocate

• Conduct outreach to members in the community to identify care gaps and connect them with appropriate healthcare services and resources
• Perform home visits or community-based assessments to evaluate member needs and identify social determinants of health
• Facilitate care coordination and help members access preventive or follow-up care
• Help members navigate healthcare and social service systems
• Assist with appointment scheduling, care-plan understanding, and access to benefits or entitlements
• Collaborate with providers using quality performance data such as HEDIS and CAHPS
• Educate members on preventive care, chronic condition management, and community resources
• Document member interactions, care gap closures, and referrals in appropriate systems
• Partner with Quality, Care Management, and Provider Relations departments
• Monitor and report outreach effectiveness and care-gap closure metrics
• Maintain compliance with state and federal regulations and organizational policies
• Participate in seasonal campaigns and quality initiatives
• Build relationships with local organizations and stakeholders as a community ambassador
• Perform other duties as assigned and comply with all policies and standards

Quality Care Advocate – Clinical

Clinician

• Perform clinical reviews and assess care related to mental health and substance abuse
• Monitor and determine whether levels of care and services are medically appropriate
• Evaluate member treatment before, during, and after services
• Perform prior authorization reviews in accordance with regulatory guidelines and criteria
• Perform concurrent reviews of behavioral health inpatient care, including treatment needs and discharge planning
• Analyze behavioral health member data to improve quality and appropriate utilization of services
• Educate providers, members, and families about the behavioral health utilization process
• Interact with behavioral health providers regarding level of care and services
• Engage with medical directors and leadership to improve care quality and efficiency
• Formulate and present cases in staffing and integrated rounds
• Comply with all policies and standards
• Perform other duties as assigned

Utilization Review Clinician – Behavioral Health

Analyst

• Serve as a senior subject matter expert for HEDIS quality oversight, audit readiness, and submission support activities
• Independently lead complex NCQA audit workstreams, including Roadmaps, Section 5 documentation, measure-specific evidence, CAHPS, and auditor communications
• Interpret and apply federal and state regulatory requirements to HEDIS documentation, workflows, and data use
• Provide expert guidance on reporting population applicability/management, measure selection, and submission requirements
• Identify, assess, and mitigate audit and submission risks
• Lead root cause analysis and develop corrective actions for high-risk or complex issues
• Support CMS submission activities, including PLD coordination, testing validation, and final submission readiness
• Develop, refine, and maintain enterprise standards, templates, controls, and documentation
• Act as an escalation point for complex audit findings, regulatory interpretation questions, and submission decisions
• Contribute to leadership-level reporting, audit narratives, and governance materials
• Drive continuous improvement initiatives to strengthen HEDIS audit readiness and submission accuracy
• Perform other duties as assigned
• Comply with all policies and standards

Senior HEDIS Quality & Audit Analyst

• Ensure patients receive the right medication, understand medication use, and resolve drug therapy issues before dispensing
• Review and accurately enter prescription orders
• Provide patient counseling and education about medications and treatment plans
• Verify prescription data entry for completeness and accuracy
• Conduct drug utilization reviews and resolve therapy-related concerns
• Partner with clinics to clarify and obtain prescriptions
• Coordinate and participate in pharmacy services, dispensing, quality assurance, and clinical monitoring
• Assess pharmaceutical needs and plan service provision
• Participate in patient care plans and quality assessment and improvement plans
• Evaluate prescription appropriateness, including dosage, drug choice, interactions, route, and stability
• Supervise filling, receiving, compounding, and dispensing activities
• Maintain complete patient charts and ensure required laboratory tests are ordered, obtained, and discussed
• Provide patient counseling, education, monitoring, and clinical interventions
• Assess therapy response, compliance, and drug regimens; report and manage adverse events
• Support physicians, nurses, and patients with clinical and technical needs
• Document communications in patient charts
• Maintain paperwork required by state and federal agencies and the Joint Commission
• Assist the Pharmacy Manager with procedures, training, and supervision of pharmacy personnel
• Participate in performance improvement projects and in-service programs
• Complete education, training, competency, and skills assessment requirements
• Participate in the on-call schedule
• Perform other tasks assigned by the Pharmacist-In-Charge and comply with policies and standards

Pharmacist – Hemophilia

• Ensure patients receive the right medication, understand how to use it, and resolve drug therapy issues before dispensing
• Review and accurately enter prescription orders
• Provide patient counseling and education on medications and treatment plans
• Verify prescription data entry for completeness and accuracy
• Conduct drug utilization reviews and resolve therapy-related concerns
• Partner with clinics to clarify and obtain prescriptions
• Coordinate and assist with pharmacy services, dispensing, quality assurance, and clinical monitoring
• Assess pharmaceutical needs and participate in pharmaceutical service planning and the overall plan of care
• Evaluate prescription appropriateness, including dosage, drug choice, interactions, administration route, and stability
• Supervise filling, receiving, compounding, and dispensing activities
• Ensure patient charts contain allergies, height, weight, medical history, laboratory results, and medications
• Ensure necessary laboratory tests are ordered, results obtained, and discussed with nurses and physicians
• Provide counseling, education, monitoring, and clinical interventions
• Assess therapy response and compliance; review regimens and manage adverse events
• Provide clinical and technical support to physicians, nurses, and patients
• Document communications in patient charts
• Maintain paperwork required by state and federal agencies and the Joint Commission
• Assist the Pharmacy Manager with new procedures
• Train and supervise Pharmacy Technicians, Pharmacy Interns, and other pharmacy personnel
• Participate in Performance Improvement Projects
• Provide in-service programs on drug therapy
• Attend or complete education and training programs
• Review pharmacy literature and pertinent materials
• Complete competency and skills assessments
• Participate in the on-call schedule
• Perform other tasks determined by the Pharmacist-In-Charge
• Comply with policies and standards

Pharmacist – Specialty

General Counsel

• Provide legal advice and strategic support to Centene’s Medicare Advantage, Part D, and Duals products
• Serve as lead legal counsel for Wellcare, Centene’s Medicare brand
• Advise business and compliance partners on healthcare laws, regulations, and guidance impacting Medicare
• Research, analyze, and interpret complex healthcare regulatory requirements related to Medicare operations, risk adjustment, MLR, quality, stars, and agent/broker matters
• Take on increasing responsibility for national-level and/or company-wide legal matters
• Review, draft, and negotiate contracts, policies and procedures, and related documents
• Provide practical legal guidance for implementing new laws, regulations, business initiatives, policies and procedures, and operational workflows
• Manage provider disputes
• Partner with product leaders, Compliance, Population Health, Network, Finance, and other business leaders to identify risks, develop practical solutions, and support timely decision making
• Manage outside counsel as necessary to ensure efficient, high-quality legal services
• Perform other duties as assigned
• Comply with all policies and standards

Vice President, Associate General Counsel

Operations

• Coordinate, negotiate, and handle departmental activities
• Aid the chief administrative officer in formulating and administering organization policies and procedures
• Manage departmental workflow and maintain production and quality standards
• Ensure compliance with applicable laws, regulations, and executive orders
• Review and analyze reports, records, and directives
• Confer with staff to obtain data for planning work-function activities
• Establish the department’s strategic vision, objectives, policies, and procedures
• Evaluate and implement improved procedures and practices
• Coordinate assigned work-function or departmental activities with related departments
• Analyze departmental and organizational reports and records
• Disseminate relevant information to business unit leaders for effective decision-making

Director, Operations

Care Coordinator

• Support administrative care management activities, including member outreach, inbound calls, and service scheduling
• Serve as a point of contact for members, providers, and staff to resolve issues
• Contact members by phone regarding care-plan next steps, community or health-plan resources, scheduling questions, concerns, and ongoing education
• Connect members with health-plan and community resources to support high-quality customer care
• Apply working knowledge of assigned health plan activities and resources
• Handle member and provider inquiries, requests, and concerns, including explaining care-plan procedures and protocols
• Support member onboarding and administrative duties, including sending welcome letters, correspondence, and educational materials
• Document and maintain non-clinical member records in accordance with state and regulatory requirements
• Make referrals to address Social Determinants of Health needs
• Perform other duties as assigned
• Comply with all policies and standards

Care Management Support Coordinator II

Authorization Specialist

• Support prior authorization requests and ensure they are addressed properly within contractual timelines
• Aid the utilization management team in documenting authorization requests
• Obtain accurate and timely documentation for member healthcare eligibility and access
• Support authorization requests according to the insurance prior authorization list
• Perform data entry to maintain and update authorization requests in the utilization management system
• Assist with tracking and documenting authorizations and referrals according to policies and guidelines
• Document medical information including history, diagnosis, and prognosis for clinical reviewer determination
• Stay up-to-date on healthcare, authorization processes, policies, and procedures
• Perform other assigned duties
• Comply with all policies and standards

Authorization Specialist I

Vice President

• Direct provider network and contracting activities
• Lead provider network strategy, including access analysis, network operations, reimbursement analysis, and unit cost management
• Oversee coordination and negotiation for the contracting department
• Establish the department’s strategic vision, objectives, policies, and procedures
• Develop, implement, and maintain production and quality standards for the Contracting department
• Oversee network development staff and external consultants developing provider networks across expansion markets
• Analyze provider networks from cost, coverage, and growth perspectives
• Evaluate opportunities to expand or change the network to meet Company goals
• Manage budgeting and forecasting initiatives for product-line network costs and provider contracts
• Oversee analysis of claims trend data and market information to support contract negotiations
• Review provider contracting rates to ensure alignment with overall Company strategy
• Support market expansion and M&A activities through provider contract analysis for due diligence
• Assist health plan CEOs and/or COOs, vendors, in key provider relations and strategy
• Travel up to 25%
• Perform other assigned duties and comply with policies and standards

Vice President, Network Development – Contracting

• Develop, assess, and facilitate complex care management activities for members with primarily physical needs
• Evaluate member needs, barriers to care access, and social determinants of health
• Develop personalized care plans/service plans and collaborate with providers, specialists, and community resources
• Identify problems and barriers to care and provide appropriate care management interventions
• Coordinate among members, families/caregivers, and care provider teams to ensure person-centered care
• Follow up and monitor member status, condition changes, and progress toward care plan goals
• Revise or update care plans with members, caregivers, and providers as needed
• Provide resource support for employment, housing, participant direction, independent living, justice, and foster care services
• Facilitate care management and timely access to needed care and services
• Conduct telephonic, digital, home, and/or other site outreach
• Collect, document, and maintain member information and care management activities for regulatory compliance
• Educate members and families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits
• Provide leadership feedback on opportunities to improve care and quality delivery cost-effectively
• Perform other assigned duties and comply with policies and standards

• Develop, assess, and facilitate complex care management activities for members with primarily physical needs
• Provide high-quality, cost-effective healthcare outcomes through personalized care plans and education
• Evaluate member needs, access barriers, and social determinants of health
• Develop ongoing care plans and collaborate with providers, specialists, and community resources
• Identify problems and barriers to care and provide appropriate interventions
• Coordinate between members, families/caregivers, and care provider teams
• Monitor member status, condition changes, and progress toward care plan goals
• Revise or update care plans as needed to meet member goals and unmet needs
• Provide resource support for services such as employment, housing, participant direction, independent living, justice, and foster care
• Facilitate care management and ensure timely access to needed care and services
• Perform telephonic, digital, home, and/or other site outreach
• Collect, document, and maintain member information and care management activities for regulatory compliance
• Educate members and families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits
• Provide leadership feedback on opportunities to improve care and quality delivery
• Perform other assigned duties and comply with policies and standards

Maternity RN Care Manager

• Support Clinical Policy by ensuring accurate coding of Clinical Coverage Guidelines and Claims Edit Guidelines
• Maintain authorization management tools, including the Auth Lookup Tool and Quick Reference Guides
• Review and update evidence-based clinical policies, coding rules, regulations, and authorization rules
• Lead revisions and development of Claims Edit Guidelines
• Research state and federal regulations, coding industry guidelines, and related policies
• Support clinical decision-making through evidence-based criteria and authorization rules
• Oversee hand-off of guidelines to the Coding Integrity team and ensure system edits are implemented
• Support Chief Medical Director projects, vendor coordination, Medical Expense Initiatives, strategic initiatives, Medicaid admits, and authorization rules
• Evaluate claims coding rule-change requests from clinical, financial, and claims operations perspectives
• Provide regulatory and coding research for Medical Expense Initiatives and contractual or implementation changes
• Serve as coding subject matter expert for markets and departments, supporting operations, product development, implementation, health outcomes, and growth initiatives
• Support Medicare pre-service turnaround time and appeals projects and standardization of authorization processes
• Apply CMS risk adjustment guidelines and assess ICD code impacts on the CMS HCC risk adjustment model
• Coordinate activities to meet contractual, regulatory, and internal standards
• Deliver clinical policies to the Medical Management Platform and Digital Communications, auditing both access points for accuracy
• Prepare Clinical Policy Updates for markets and leadership
• Liaise between Medical Management and Systems Integration regarding coding inquiries
• Participate in cross-functional projects involving Claims, Product, Operations, markets, and Medicare Planning
• Assist with logistics and serve as a coding and claims-payment subject matter expert on the Medical Policy Committee and Claims Payment Policy Committee
• Communicate policy changes to markets and collect feedback
• Perform other duties as assigned

Pharmacy Technician I – Specialty Outreach

Care Manager, RN

Quality Care Advocate – Clinical

Utilization Review Clinician – Behavioral Health

Senior HEDIS Quality & Audit Analyst

Pharmacist – Hemophilia

Pharmacist – Specialty

Vice President, Associate General Counsel

Director, Operations

Care Management Support Coordinator II

Authorization Specialist I

Vice President, Network Development – Contracting

Care Manager, RN

Maternity RN Care Manager

Clinical Policy Coding Analyst