Browse current Centene Corporation openings that JobDrop found directly from the company's careers source.
Position Purpose: Leads Centene's vendor AI review and integration standards function, accountable for ensuring that third-party and vendor-supplied AI capability entering the enterprise is properly assessed, architecturally suitable for Centene's AI Control Plane, and held to defined integration and interoperability s
Position Purpose: Leads enterprise AI use case intake, portfolio lifecycle management, and governance process flow/operations (not policy creation) for Centene, serving as the single front door and system of record for AI from idea through production and eventual decommissioning. Owns the end-to-end AI lifecycle workfl
Position Purpose: Leads Centene's enterprise AI productivity and LNCN (low-code/no-code) function, with accountability for how employees across the enterprise adopt, build with, and derive measurable value from approved personal productivity and low-code/no-code AI tools. Owns the low-code/no-code (LCNC) enablement exp
Position Purpose: Manage and support the development of network performance analytics. Design and build solutions that create, maintain, interface, or transform data in order to support a complete business need around contracting analytics and modeling applications. Key Details: This field-based opportunity offers the
Position Purpose: Responsible for developing digital content thru Sales Force Marketing Cloud (SFMC) or similar communications platform within the member engagement and communications team. Project manage the cross functional communication calendar to ensure deployment of all communication. Key Details: Eexperience wit
Position summary: Analyze program outcomes and collaborate with various stakeholders to implement action plans to improve and optimize results. Handle complex Outcomes Analysis projects and may act as a subject matter expert to other Outcomes Analysts. Key Details: Must be authorized to work in the U.S. without the nee
Position Purpose: Responsible for developing digital content thru Sales Force Marketing Cloud (SFMC) or similar communications platform within the member engagement and communications team. Project manage the cross functional communication calendar to ensure deployment of all communication. Key Details: Eexperience wit
Position Purpose: The Program Manager II provides strategic program management for Population Health Analytics initiatives that support provider engagement, quality, and operational performance. This role leads complex, cross-functional programs from planning and requirements through implementation and post-launch eval
Position Purpose: Conduct analysis, pricing, and risk assessment to estimate financial outcomes while supporting the Risk Adjustment team through data analytics, risk adjustment modeling, and complex data validation initiatives. Key Details: Candidates must have either 7+ years of actuarial experience with an ASA desig
Position Purpose: The Manager, Training provides leadership and strategic oversight for Marketplace Member Services and designated Medicaid training teams. This role drives cross-functional alignment across Training, Instructional Design, Knowledge Management, Quality, business leaders, and Service Partner Training to
Position Purpose: Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing. Perform duties as the point of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators. Key Details: This is a remote position and the schedu
Position Purpose: Facilitate new business opportunities, identify market trends and manage product development for the assigned products. Serve as a liaison between Actuarial, Network, Sales, Implementation, and Operations to ensure a smooth and unified new product development and ongoing product management. - Work wit
Position Purpose: Lead and direct process improvement activities that provide more efficient and streamlined workflow. Key Details: Must reside in Indiana or be willing to relocate to Indiana. - Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or
Position Purpose: Direct, negotiate and handle activities of the business unit’s finance department and aid in formulating and administering organization financial policies and procedures. - Monitor business processes and systems to assure integrity in information and systems - Oversee preparation of accurate and timel
Position Purpose: With the Carolina Complete Health Plan Risk Adjustment team, you will plan, organize, monitor, and oversee risk adjustment projects along with tracking monthly goals, assigning project tasks to Risk Adjustment Coordinators, outreach to Providers for project related issues, meet or exceed Annual Risk A
Position Purpose: The Intake Representative I enters specific data/information from physicians’ requests into a medical management authorization system, achieving required production quota/quality standards. Key Details: Qualified candidates must be located in the state of Missouri. Must be authorized to work in the U.
Position Purpose: Performs access reviews, role provisioning, and supporting implemented Identity and Access Management systems and solutions. Supports basic troubleshooting and coordinates with helpdesk to resolve user and system access issues. Provides in-depth business knowledge and advanced technical support to one
Position Purpose: Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates to the business as a subject matter expert on various complex topics. Performs state or federal policy research and regulatory change monitoring with a goal of achieving formal regulatory approval of Commercial/
The Care Manager will provide complex, high-risk care management for pediatric members. Responsibilities include conducting assessments, developing care plans, completing screenings, and connecting members with appropriate resources. The Care Manager will also support other Care Managers by answering questions and prov
Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account
The Care Manager will provide care management and coordination for pediatric members from birth through age five. Responsibilities include conducting assessments and screenings, developing care plans, and connecting members and their families with appropriate resources. This position supports the Pediatric Care Managem
Candidates must have maternity care management experience and live in North Carolina. Experience working with the pediatric population is also required. In this role, you’ll manage care for members with complex, high-risk needs. Responsibilities include conducting assessments, developing care plans, completing screenin
Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account
Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care plan / service plan
Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care plan / service plan
Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account
Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Key Details: This fully remote, Monday–Frid
Position summary: Analyze program outcomes and collaborate with various stakeholders to implement action plans to improve and optimize results. Handle complex outcomes analysis projects and may act as a lead for other Outcomes Analysts. Key Details: Must be authorized to work in the U.S. without the need for employment
Position Purpose: Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services an
Position Purpose: Performs receptionist duties and provide administrative support to the executive assistants. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, inclu
Position Purpose: Directs multiple teams accountable for designing, developing, and implementing complex enterprise software solutions. Provides technical guidance to engineering teams and implements best practice development methods. Manages a large portfolio of new development, enhancements, maintenance projects to s
Position Purpose: Supervises Prior Authorization, Concurrent Review, Retrospective Review Clinical Review and/or Appeals team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. Key Details: This is a remote position; however, candidates must reside in Oklahoma and ho
Position Purpose: Represents the highest level of technical expertise in the area of Provider Configuration, Provider, and Network Maintenance while providing leadership and partnering with Fidelis Care New York’s Senior and Executive Management. Key Details: People Leader managing SLAs, knows configuration well, and c
Position Purpose: Manages Prior Authorization, Concurrent Review, Retrospective Review Clinical Review and/or Appeals team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and facilitates operations within utilization management. Key Details: Th
Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through home-visits and documen
Position Purpose: Responsible for driving the product performance function for assigned products, across multiple lines of business. Oversee the review of product performance, the analysis of performance of products, the coordination of product improvement initiatives, and the preparation of executive leadership for re
Position Purpose: Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers. Key Details: Candidate
Position Purpose: Assist in the planning, implementation and evaluation of the state wide marketing & communication programs Key Details: Candidates must reside in Southern Indiana (Evansville highly preferred). This role will support the following counties: Bartholomew, Brown, Clark, Clay, Crawford, Daviess, Dubois, F
Position Purpose: Coordinate and monitor quality improvement and organizational projects from inception to closure. Perform duties and functions as required to develop and implement quality improvement programs and initiatives at both the corporate and individual health plan levels according to NCQA, URAC and State req
Position Purpose: Manage Specialty Therapy and Rehabilitation Services (STRS) clinical services including management and marketing of clinical services. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are
Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Key Details: Candidates must reside in Arizona and be able to work full-time, in office at our Tempe, AZ location. Mail-order experience is preferred. - Gathe
Position Purpose: The Principal Incident Response Analyst serves as an Incident Commander for activities requiring the issuance of Centene’s enterprise-wide Incident Response Plan. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorshi
Position Purpose: Relieves the executive of administrative type functions in order to increase the time the executive has available for senior level responsibilities. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future s
Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregiver
Position Purpose: Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. - Learn various job functions within the Managed Care industry and explore various career opportunities - Apply academic knowledge and learn ne
Position Purpose: Performs as the advocate that focuses on resolving routine inquiries, issues or concerns for members and/or providers. Leverages a variety of communication channels to provide members and/or providers with timely, accurate, and personalized support on routine complaints and escalations. Key Details: M
Position Purpose: Perform day to day duties of assuring that providers are set up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provi
Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account
Position Purpose: Designs, develops, and implements complex enterprise software solutions. Collaborates closely with technical and non-technical roles such as data modelers, architects, business analysts, data stewards, and subject matter experts (SMEs) to provide design, technical analysis, development/configuration,
Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregiver
Position Purpose: Supports the Security Culture, Training and Awareness (SCTA) team by turning program data into decision-ready insights for leaders and stakeholders. Defines, builds, and maintains repeatable metrics and KPI reporting (e.g., awareness campaign performance, training completion, phishing simulation resul
Position Purpose: 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 indiv
Position Purpose: The Manager of Clinical Pharmacy Operations is responsible for developing, implementing and administering clinical pharmacy tools and programs to support corporate and regional drug utilization and financial goals. Key Details: This position is fully remote. The ideal candidate will have people leader
Position Purpose: Perform duties related to the day-to-day operations of the Service Management functions for Foster Care members to achieve the highest possible levels of functioning and wellness by ensuring consistent, timely access to medically necessary behavioral health services. Monitor quality of care, assist wi
Position Purpose: Supports community connection activities including connecting members to community resources to support their care management journey and provide necessary care resources in a cost-effective manner. Provides members with known community resources and supports the care team to identify member community
Position Purpose: Supports community connection activities including connecting members to community resources to support their care management journey and provide necessary care resources in a cost-effective manner. Provides members with known community resources and supports the care team to identify member community
Position Purpose: Supports community connection activities including connecting members to community resources to support their care management journey and provide necessary care resources in a cost-effective manner. Provides members with known community resources and supports the care team to identify member community
Position Purpose: The Senior Health Benefit Representative (SHBR) is responsible for educating and assisting individuals with enrolling in affordable health insurance coverage through the NY State of Health Marketplace. This includes Medicaid (NYM), Child Health Plus (CHP), Essential Plan (EP), Qualified Health Plans (
Position Purpose: Supports community connection activities including connecting members to community resources to support their care management journey and provide necessary care resources in a cost-effective manner. Provides members with known community resources and supports the care team to identify member community
Position Purpose: The Health Benefit Representative (HBR) is responsible for educating and assisting individuals with enrolling in affordable health insurance coverage through the NY State of Health Marketplace. This includes Medicaid (NYM), Child Health Plus (CHP), Essential Plan (EP), Qualified Health Plans (QHP), an