Centene Corporation

Analyst

• Track and manage the IT asset life cycle from selection and depreciation through retirement and replacement
• Identify, control, record, report, audit, and verify configuration items and asset records, including versions, baselines, components, attributes, and relationships
• Plan, monitor, and record hardware assets and software licenses for vendor-contract and asset-lifecycle compliance
• Improve technology-spending strategies and asset tracking in the CMDB and other asset-management tools
• Manage CMDB and asset-management tool accuracy
• Provide KPI/metric information and standardized scheduled and ad-hoc reporting
• Define and enhance identification schemes for hardware, software assets, and configuration items
• Manage CI and asset inventories, dependencies, attributes, modifications, withdrawals, and additions
• Verify and audit CMDB and asset-management content; reconcile software licenses and physical hardware inventory; initiate corrective actions and reclamation
• Design and improve software and hardware asset-management processes
• Create, monitor, and track requisitions through purchase-order creation and validate incoming-order accuracy
• Support the Brentwood depot and O'Fallon data center, traveling between locations as needed
• Operate material-handling equipment and perform other assigned duties while complying with policies and standards

Asset and Configuration Analyst II

Team Lead

• Perform administrative care management activities, including member outreach, answering inbound calls, and scheduling services
• Provide phone outreach to members regarding care plan next steps, community or health plan resources, scheduling questions, concerns, and ongoing education
• Connect members with health plan and community resources
• Serve as front-line support for member and provider inquiries, requests, and concerns
• Explain care plan procedures and protocols
• Support member onboarding and administrative duties, including sending welcome letters, correspondence, and educational materials
• Escalate requests and inquiries to management
• Document and maintain non-clinical member records in accordance with state and regulatory requirements
• Assist People Leaders with weekly data reporting, up to 50% of the role
• Present findings and data to People Leaders and peers
• Support training of new hires
• Comply with all policies and standards
• Perform other duties as assigned

Team Lead, Care Management Support Coordinator

General

• Serve as the senior individual contributor and enterprise-level subject-matter expert for Payment Integrity systems, platform governance, analytics, financial reporting, and operational visibility
• Lead enterprise-level analysis of Payment Integrity system, claims, workflow, financial, and reporting data
• Identify strategic risks, prioritization decisions, savings opportunities, and operational improvement recommendations
• Set standards for technical review, data validation, dashboarding, reporting routines, ServiceNow intake, defect/enhancement prioritization, UAT/release readiness, post-release issue tracking, and operational visibility
• Serve as the senior business-technology liaison for platform change management
• Align Operations, Technology, Finance, governance, and leadership stakeholders on scope, impact, risk, decisions, and readiness
• Own operating routines governing incidents, defects, enhancements, releases, automation opportunities, and modernization workstreams
• Translate complex cross-platform results into executive-ready summaries, strategic recommendations, implementation plans, and measurable success criteria
• Advise leadership on platform governance, financial reporting, data quality controls, process standardization, and long-term system capability needs
• Lead continuous improvement of methodologies, standards, and job-family consistency across Payment Integrity system support and analytics functions
• Provide technical leadership, coaching, peer review, and escalation support to PI Systems Specialist I, II, and Senior PI Systems Specialist team members
• Perform other duties as assigned
• Comply with all policies and standards

Lead Payment Integrity Systems Specialist

• Conduct moderately complex analysis of Payment Integrity platform outputs, claims system data, edit/rule behavior, financial/reporting outputs, and workflow performance
• Identify exceptions, trends, and operational impacts
• Manage ServiceNow or similar incidents, defects, enhancement requests, and intake items
• Document requirements, track status, coordinate follow-up, and escalate blockers
• Coordinate UAT, regression testing, validation, and release-readiness activities for system changes
• Validate defects and communicate operational impacts
• Develop and maintain dashboards, trackers, recurring reports, and workstream visibility tools
• Support platform enhancements, defects, metrics, savings opportunities, and operational improvement initiatives
• Gather and analyze data using Excel, SQL, Power BI, financial reporting tools, or approved reporting platforms
• Partner with Operations, Technology, Finance, governance/delivery, and business stakeholders
• Clarify requirements, document decisions, and support transformation workstreams
• Improve data quality, documentation, process consistency, and operational readiness
• Provide informal guidance or onboarding support to less-experienced team members
• Perform other duties as assigned and comply with policies and standards

Payment Integrity Systems Specialist II

Nurse

• Perform concurrent reviews to determine members’ overall health, appropriate care, setting, and level of care
• Review acuity, resource consumption, length of stay, quality, continuity of care, and discharge planning
• Work with Medical Affairs and/or Medical Directors regarding member care
• Document concurrent review findings, discharge plans, and actions in health management systems
• Work with healthcare providers to approve medical determinations or provide recommendations
• Educate providers on utilization processes
• Provide leadership feedback on level-of-care and medical-necessity improvements
• Review transfer and discharge plans to support timely transitions
• Collaborate with care management on member referrals
• Comply with policies and standards and perform other assigned duties

Clinical Review Nurse – Concurrent Review

Manager

• Develop, assess, and facilitate complex care management activities for members with primarily mental and behavioral health needs
• Provide personalized care plans and education for members and families related to mental health and substance use disorder
• Evaluate member needs by phone or in-home visits and recommend or facilitate care/service plans
• Conduct telephonic, digital, home, and other site-visit outreach
• Develop ongoing care plans for high-acuity members and identify providers, specialists, and community resources
• Coordinate among members, families/caregivers, community resources, and care provider teams
• Monitor care plans, member status, outcomes, treatment side effects, complications, and clinical symptoms
• Facilitate care coordination and collaborate with providers and specialists to ensure timely access to care
• Collect, document, and maintain member information and care management activities for regulatory compliance
• Educate members and families on procedures, provider instructions, treatment options, referrals, and healthcare benefits
• Provide leadership feedback on opportunities to improve cost-effective care and quality delivery
• Comply with all policies and standards and perform other duties as assigned

Care Manager

Program Manager

• Support strategic planning, development, and execution of SIU proactive anti-fraud detection, tools, analytics programs, initiatives, and priorities
• Transform large and complex data sets into defensible, actionable analytical insights for investigative lead generation, case development, fraud prevention, and data-driven decision-making
• Leverage HCFS PostShield, AI Shield, Pharmacy Shield, and other internal and external data assets to identify emerging risks and develop detection strategies
• Partner with SIU leadership and enterprise stakeholders to design and implement analytical methodologies, predictive monitoring solutions, dashboards, performance metrics, and reporting capabilities
• Collaborate across SIU, Claims, Configuration, IT, Clinical, Compliance, Market Operations, and external partners
• Research, evaluate, and monitor emerging fraud schemes, industry trends, regulatory developments, and analytical opportunities
• Communicate analytical findings, fraud trends, program performance, financial impact, risks, and strategic recommendations to senior leadership and stakeholders
• Maintain audit-ready documentation, including program roadmaps, governance artifacts, risk and decision logs, methodology documentation, claim volume analyses, performance metrics, and financial impact reporting
• Perform other duties as assigned
• Comply with all policies and standards

Program Manager III – SIU Intelligence, Innovation

Vice President

• Oversee provider network and contracting activities
• Lead provider network strategy, including access analysis and network operations
• Support decision makers with reimbursement and unit cost management analysis
• Oversee coordination and negotiation for the contracting department
• Analyze information to support contract negotiations
• Ensure development of provider networks across expansion markets
• Evaluate provider network cost, coverage and growth and recommend expansion opportunities
• Oversee budgeting and forecasting initiatives for product-line network costs and provider contracts
• Review provider contracting rates for alignment with company strategy
• Participate in unit cost and selective contracting initiatives
• Establish the department's strategic vision, objectives, policies and procedures
• Develop, implement and maintain production and quality standards
• Support market expansion and M&A activities through provider contract analysis for due diligence
• Assist the health plan CEO and/or COO vendors with key provider relations and strategy
• Perform other duties as assigned
• Comply with all policies and standards

VP, Network Development – Contracting

• Develop, assess, and facilitate complex care management activities for members with primarily mental and behavioral health needs
• Create personalized care plans and educate members and families about mental health and substance use disorder needs
• Evaluate member needs by phone or in-home visits and recommend or facilitate care and service plans
• Conduct telephonic, digital, home, and other site-visit outreach
• Develop ongoing care plans for members with high acuity
• Identify providers, specialists, and community resources for mental health and substance use disorders
• Coordinate among members, families, caregivers, community resources, and care provider teams
• Monitor care plans, member status, treatment side effects, complications, and clinical symptoms
• Facilitate care coordination and timely access to needed services
• Document member information and care management activities
• Educate members and families on procedures, provider instructions, treatment options, referrals, and healthcare benefits
• Provide leadership feedback on opportunities to improve quality and cost-effective care delivery
• Perform other duties as assigned
• Comply with all policies and standards

Business Analyst

• Perform analysis and interpretation to link business needs and objectives for the assigned function
• Research, identify, validate, and document overpaid claims and recovery opportunities through claims analysis, reimbursement review, coding validation, and application of regulatory and payment policy guidelines
• Monitor and analyze recovery concepts and claim outcomes throughout the review lifecycle
• Collaborate with Medical Economics, Payment Integrity Operations, Claims, and BTS to investigate issues, validate results, and optimize savings performance
• Support business initiatives through data analysis, identification of implementation barriers, and user acceptance testing of new systems
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Perform detailed analysis on assigned projects, recommend business solutions, and assist with implementation
• Enhance performance management and operational reports related to new business implementation processes
• Develop and incorporate organizational best practices into business applications
• Lead problem-solving and coordination efforts between various business units
• Assist with formulating and updating departmental policies and procedures
• Perform other duties as assigned
• Comply with all policies and standards

Payment Integrity Business Analyst II

Care Coordinator

• Develops, assesses, and coordinates holistic care management activities for long-term care members
• Develops or assists with personalized service care plans and educates members and caregivers on available services and benefits
• Evaluates member needs and available resources and recommends or facilitates appropriate care plans
• Identifies providers, specialists, and community resources for long-term care
• Coordinates members, caregivers, and care provider teams to ensure services are accessible
• Provides resource support for employment, housing, participant direction, independent living, justice, and foster care needs
• Monitors care plans, member status, and outcomes and recommends updates based on member needs
• Interacts with long-term care providers and partners
• Collects, documents, and maintains member information and care management activities for regulatory compliance
• May conduct on-site visits to assess member needs and collaborate with providers or resources
• Educates members and caregivers on procedures, provider instructions, service options, referrals, and healthcare benefits
• Provides leadership feedback on opportunities to improve quality of care and cost-effective service delivery
• Performs other assigned duties

LTSS Service Care Coordinator

Supervisor

• Supervise the care coordination team serving long-term care members
• Promote quality and efficacy of care management delivery
• Supervise day-to-day escalations and care management issues involving members or providers
• Maintain a small member caseload within an assigned southwest and south-central Iowa territory
• Conduct in-person member visits, assessments, and care coordination activities through regular service-area travel
• Monitor and review required long-term care management documentation for compliance
• Assign caseloads and work assignments based on state requirements, staff experience, and member needs
• Collaborate with senior management on escalated and complex care cases
• Guide junior team members in addressing member concerns
• Educate and provide resources to the care management team on initiatives and member outreach
• Evaluate team performance and provide feedback on performance, goals, and career milestones
• Coach and guide the team to improve member and provider experience and deliver high-quality care
• Assist with onboarding, hiring, and training team members
• Lead and champion change within the scope of responsibility
• Perform other duties as assigned

Supervisor, Care Management – LTSS

• Support healthcare vendor performance, cost, savings, and return-on-investment analyses
• Extract claims and member data using SQL and clean large datasets for analysis
• Analyze data in Excel and build or maintain Power BI dashboards
• Create visualizations, presentations, and summaries explaining findings to business stakeholders
• Learn processes and functions within the Managed Care industry
• Contribute to projects supporting the business and apply academic knowledge
• Research legal, regulatory, and other topics within the functional area and industry
• Attend training and development presentations
• Perform other duties as assigned
• Comply with all policies and standards

Medical Economics Analyst Intern, Undergraduate

• Conduct inpatient concurrent reviews to assess medical necessity using InterQual criteria, corporate and state policies, and available review tools
• Support New Hampshire Medicaid through the East Region Shared Services team
• Perform concurrent reviews to determine members’ overall health, appropriate care, and level of care
• Review acuity level, resource consumption, length of stay, and discharge planning
• Work with Medical Affairs and/or Medical Directors regarding member care
• Collect, document, and maintain concurrent review findings, discharge plans, and actions in health management systems
• Work with healthcare providers to approve medical determinations or provide recommendations
• Educate providers on utilization processes
• Provide leadership feedback on level-of-care and medical-necessity improvement opportunities
• Review transfer or discharge plans to ensure timely transitions between levels of care and facilities
• Collaborate with care management on member referrals
• Comply with all policies and standards and perform other assigned duties

• Perform concurrent reviews, including determining members’ overall health, reviewing the type of care delivered, evaluating medical necessity, and contributing to discharge planning
• Evaluate inpatient services to validate the necessity and setting of care delivered
• Determine appropriate care and setting by reviewing acuity level, resource consumption, length of stay, and discharge planning
• Work with Medical Affairs and/or Medical Directors regarding member care
• Collect, document, and maintain concurrent review findings, discharge plans, and actions taken in medical records and health management systems
• Work with healthcare providers to approve medical determinations or provide recommendations
• Educate providers on utilization processes
• Provide leadership feedback on opportunities to improve level of care and medical necessity
• Review transfer or discharge plans to ensure timely discharge
• Collaborate with care management on member referrals
• Comply with all policies and standards
• Perform other duties as assigned