Centene Corporation

Executive Assistant

• Provide executive assistant support to the Chief Information Officer
• Lead and provide executive-level support in partnership with multiple internal partners
• Provide direct administrative and professional support to the EVP with minimal or no supervision
• Work closely with administrative support teams to assist multiple internal partners
• Perform advanced, diversified, and confidential administrative duties
• Research, prioritize, and determine appropriate action for business matters
• Gather information for board meetings, programs, events, and conferences
• Arrange facilities and caterers, issue information or invitations, coordinate speakers, prepare materials, and assist with event budget control
• Prepare and coordinate materials, records, statistics, letters, memos, and operational reports

Executive Assistant – Office of CIO

Manager

• Develop, assess, and coordinate holistic care management activities for members with significant mental/behavioral health needs
• Evaluate member service needs and develop or contribute to care plans and service plans
• Educate members, families, and caregivers about available services, benefits, preventive care, treatment options, referrals, medication regimens, and healthcare benefits
• Evaluate complex and high-risk members and recommend plans of care
• Act as liaison and member advocate among members/families, physicians, and facilities/agencies
• Support members with mental and behavioral health conditions
• Conduct frequent home and other site visits, including up to 75% monthly travel, to assess member needs and collaborate on resources
• Provide subject matter expertise and operational support for behavioral health activities, including crisis calls, mental health first aid training, field safety, de-escalation, and medication monitoring
• Educate on and coordinate medical, behavioral, and social community resources
• Coordinate service authorizations for services such as meals, employment, housing, foster care, transportation, and activities of daily living
• Make referrals and support identification of providers, specialists, and community resources
• Maintain accurate documentation in the electronic care management system and support compliance with clinical, state, and federal guidelines
• Provide leadership feedback on quality-of-care and service-delivery improvements
• Comply with policies and standards and perform other assigned duties

LTSS Service Care Manager – Behavioral Health

• Assess, plan, and coordinate medical and supporting services for post-discharge members
• Complete medication reviews and reconcile pre-admission and post-discharge medications
• Develop care/service plans and support member transition and discharge needs
• Assess member health status, resource needs, services, and treatment plans; provide appropriate interventions
• Facilitate transition into active care management based on member needs
• Provide or facilitate education and resource materials for members, caregivers, and providers
• Coordinate services among PCPs, specialists, medical providers, and non-medical resources
• Conduct telephonic, digital, home, and/or other site outreach
• Collect, document, and maintain member information and care management activities
• Provide leadership feedback on opportunities to improve care quality and cost-effectiveness
• Comply with policies and standards and perform other assigned duties

Care Manager, Transition of Care (RN)

• Assess and coordinate medical and supporting services across the continuum of care for complex/high-acuity populations
• Develop personalized long-term care and service plans
• Evaluate service needs and recommend plans for optimal outcomes
• Continuously assess care plans and collaborate with care management teams, providers, specialists, and community resources
• Coordinate members, families/caregivers, and care provider teams to ensure appropriate person-centered care
• Monitor member status, complications, clinical symptoms, changes in condition, and progress toward goals
• Review member data, referrals, and intake assessments to improve care quality and develop appropriate plans
• Facilitate member services, treatments, service authorizations, and community resources
• Collect, document, and maintain member information and care management activities in compliance with regulations and guidelines
• Educate members and families/caregivers about disease processes, care gaps, provider instructions, care options, referrals, and benefits
• Act as liaison and advocate between members/families, physicians, facilities, and agencies
• Conduct home and other site visits, including member assessments
• Partner with leadership to improve quality and cost-effective service delivery
• May precept and coach clinical new hires during onboarding
• Perform other duties as assigned and comply with policies and standards

Senior RN LTSS Service Care Manager

Account Manager

• Maintain partnerships between the health plan and contracted provider networks serving communities
• Build client relations to ensure delivery of the highest level of care to members
• Engage with providers to align on network performance opportunities and solutions
• Provide consultative account management and accountability for issue resolution
• Drive optimal performance in contract incentive performance, quality, and cost utilization
• Serve as primary contact for providers and liaison between providers and the health plan
• Triage provider issues for resolution to internal partners
• Respond to external provider-related issues
• Investigate, resolve, and communicate provider claim issues and changes
• Initiate data entry of provider-related demographic information changes
• Educate providers on policies and procedures related to referrals, claims submission, website usage, EDI solicitation, and related topics
• Perform provider orientations and ongoing provider education, including writing and updating orientation materials
• Manage network performance for assigned territory through a consultative/account management approach
• Evaluate provider performance and develop strategic plans to improve performance
• Drive provider performance improvement in Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization
• Complete special projects and other assigned duties
• Comply with all policies and standards

Provider Engagement Account Manager

Accountant

• Develop, analyze, and execute accounting and finance functions supporting brokerage and member incentive operations
• Support brokerage and member incentive accounting activities, including monthly journal entry preparation and variance analysis
• Prepare, analyze, and upload journal entries into PeopleSoft and support month-end close activities through business day six
• Complete balance sheet reconciliations and reconcile income statements, trial balances, and other financial reports for assigned functional areas
• Prepare management and financial reports and advise on the organization’s financial status
• Develop analytical financial tools for critical balance sheet accounts and recommend enhancements to accounting methods and procedures
• Develop, implement, modify, and document accounting systems
• Maintain and roll forward Excel-based reporting files
• Assist with process improvements through automation, Copilot, and other technology solutions
• Research accounting issues and support due diligence, integration activities, technical accounting research, and other business initiatives
• Conduct special studies and support special projects
• Perform other duties as assigned and comply with company policies and standards

Senior Accountant – Brokerage, Member Incentives

• Maintain partnerships between the health plan and contracted provider networks
• Build client relations to support the highest level of care for members
• Engage providers on network performance opportunities and solutions
• Manage consultative account management and accountability for issue resolution
• Drive performance in contract incentive performance, quality, and cost utilization
• Serve as primary contact and liaison between providers and the health plan
• Triage provider issues to internal partners for resolution
• Respond to external provider-related issues
• Investigate, resolve, and communicate provider claim issues and changes
• Initiate data entry of provider demographic information changes
• Educate providers on referrals, claims submission, website usage, EDI solicitation, and related topics
• Perform provider orientations and ongoing education
• Write and update orientation materials
• Manage network performance for the assigned territory
• Evaluate provider performance and develop strategic improvement plans
• Drive improvement in Risk/P4Q, HBR, HEDIS/quality, cost, and utilization
• Complete special projects and other assigned duties
• Comply with policies and standards

Strategy

• Participate in the development of strategic business plans
• Coordinate and communicate product strategy and determine key priorities, policies, and procedures for product lines and programs
• Identify and advance growth, innovation, and member experience opportunities through market intelligence, strategic business cases, experience roadmaps, and data-driven recommendations
• Guide investment, partnerships, pilots, and organizational priorities
• Build cross-functional relationships with shared service partners and markets to implement business strategies
• Lead strategic intelligence initiatives supporting enterprise-wide decision-making
• Drive cross-functional efforts aligned with annual business and strategic plans
• Deliver recommendations based on market trends, competitor analysis, internal performance metrics, talent analytics, and macroeconomic or geographical insights
• Execute and manage strategic recommendations
• Support strategic and business planning processes
• Lead large-scale, cross-functional initiatives
• Analyze competitor data and landscapes, develop competitive dashboards, and provide analytical insights and recommendations to leadership
• Lead and mentor data analysts
• Execute complex data-related analytical projects to drive business decisions and efficiencies
• Monitor business needs and issues related to product success, including regulatory or policy changes, contract changes, industry trends, and corporate goals
• Operate as a central intelligence hub by gathering, analyzing, and distributing strategic intelligence
• Perform other duties as assigned
• Comply with all policies and standards

Senior Strategy Manager

Clinician

• Perform reviews of members’ care and health status for Applied Behavioral Analysis (ABA) services to determine medical appropriateness
• Monitor clinical effectiveness and efficiency of members’ care according to ABA guidelines
• Evaluate care and health status before, during, and after ABA services
• Perform prior authorization reviews related to behavioral health
• Analyze behavioral health member data to improve quality and utilization of services
• Interact with behavioral health providers regarding level of care and services
• Educate members and families about ABA and the behavioral health utilization process
• Provide leadership feedback on care improvement opportunities, processes, and policies
• Comply with all policies and standards
• Perform other assigned duties

Utilization Review Clinician – ABA

• Evaluate service needs of complex or high-risk/high-acuity members and recommend care plans
• Develop and continuously assess long-term care plans and service plans
• Collaborate with care management teams to identify providers, specialists, and community resources
• Coordinate between members, families/caregivers, and care provider teams
• Monitor care plans, member status, changes in condition, complications, and progress toward goals
• Review member data, referrals, and intake assessments to improve care quality and develop appropriate plans
• Collaborate with healthcare providers to facilitate services and treatments
• Collect, document, and maintain member information and care management activities
• Educate members and families/caregivers about disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits
• Act as liaison and member advocate between members/families, physicians, and facilities/agencies
• Coordinate community resources and service authorizations, including meals, employment, housing, foster care, transportation, and activities of daily living
• Perform home and other site visits, potentially monthly or more frequently, to assess needs and collaborate with resources
• Partner with leadership to improve quality of care and cost-effective service delivery
• May precept clinical new hires and provide coaching, shadowing, onboarding, and competency support
• Engage with People Leaders and cross-functional teams to monitor new-hire readiness
• Perform other assigned duties and comply with policies and standards

Senior LTSS Service Care Manager

Actuary

• Assist in financial analysis, forecasting, pricing, and risk assessment activities supporting Medicare Advantage financial performance
• Apply mathematics, probability, statistics, finance, and business principles to analyze Medicare FFS claims, savings initiatives, and provider risk-sharing arrangements
• Develop and maintain quarterly forecasts for Medicare FFS medical costs, savings initiatives, and provider risk-sharing arrangements
• Identify key trends, assumptions, and forecast variances
• Develop and run data reports to identify emerging trends and gaps
• Prepare financial and analytical exhibits
• Communicate findings to technical and non-technical audiences
• Collaborate with internal business partners on forecasting, reporting, and financial analysis needs
• Perform other duties as assigned

Senior Actuarial Analyst – Medicare

Care Coordinator

• Support administrative care management activities, including outreach, answering inbound calls, and scheduling services
• Serve as a point of contact to members, providers, and staff to resolve issues
• Document member records in accordance with current state and regulatory guidelines
• Provide phone outreach to members regarding care plan next steps, community or health plan resources, scheduling questions or concerns, and ongoing education
• Connect members with health plan and community resources
• Apply working knowledge of assigned health plan activities and resources
• Provide front-line support for member and provider inquiries, requests, and concerns
• Explain care plan procedures and protocols
• Support member onboarding and day-to-day administrative duties
• Send welcome letters, correspondence, and program educational materials
• Maintain non-clinical member records and provide records to providers as needed
• 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 – LTSS Medicaid Services

• Support the senior care management team and assigned member teams to ensure provider and partner services are delivered and continuity of care/member satisfaction is achieved
• Serve as a liaison alongside care managers and providers to coordinate member care
• Conduct member outreach by telephone and home visits
• Discuss care plans/service plans, next steps, resources, questions, concerns, and ongoing education with members
• Coordinate care activities with healthcare and community providers, partners, members, and caregivers
• Support member and provider inquiries, requests, and concerns related to care plans/service plans
• Develop knowledge of care management services and respond to complex or escalated issues
• Communicate with care managers, practitioners, and others to facilitate member services and continuity of care
• Perform service assessments/screening for members with complex needs and document care needs
• Maintain member records in accordance with state and regulatory requirements and distribute them to providers as needed
• Assist the care management team with triaging, adjusting, and escalating complex requests
• Follow contractual, regulatory, and organizational standards and policies
• Identify needs and make referrals to Care Managers, community-based organizations, and Disease Managers
• Provide education on available benefits and resources
• May assist with training and development needs
• Perform other duties as assigned

Care Coordinator III

• Support the senior care management team and teams assigned to members
• Ensure healthcare providers and partners deliver services and continuity of care/member satisfaction is achieved
• Serve as a liaison with care managers and providers to coordinate member care
• Conduct member outreach by phone and home visits
• Discuss care plans/service plans, next steps, resources, questions, concerns, and ongoing education with members
• Coordinate care activities with healthcare and community providers, partners, members, and caregivers
• Respond to member and provider inquiries, requests, and concerns
• Develop knowledge of care management services and respond to complex or escalated issues
• Communicate with care managers, practitioners, and others to facilitate member services
• Perform service assessments/screening for members with complex needs and document care needs
• Maintain member records in accordance with state and regulatory requirements and distribute records to providers as needed
• Triage, adjust, and escalate complex requests to management
• Follow contractual, regulatory, and organizational standards and policies
• Identify needs and make referrals to Care Managers, community-based organizations, and Disease Managers
• Provide education on benefits and available resources
• Assist with training and development needs as needed
• Perform other duties as assigned

• Assess and coordinate medical and supporting services across the continuum of care for complex/high-acuity populations
• Develop personalized care plans/service plans for long-term care members
• Evaluate service needs and recommend plans for optimal outcomes
• Continuously assess care plans and collaborate with care management teams to identify providers, specialists, and community resources
• Coordinate between members/families/caregivers and care provider teams to ensure appropriate person-centered care
• Monitor care plans, member status, complications, clinical symptoms, and progress toward goals
• Assess potential entry into higher levels of care and/or waiver eligibility
• Review member data, referrals, and intake assessments to improve quality and develop appropriate care plans
• Collaborate with healthcare providers to facilitate services and treatments
• Collect, document, and maintain member information and care management activities in compliance with guidelines
• Educate members and families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, benefits, and community resources
• Act as liaison and member advocate between members/families, physicians, and facilities/agencies
• Coordinate service authorizations for services such as meals, employment, housing, foster care, transportation, and activities of daily living
• Perform home and other site visits, potentially once a month or more, to assess member needs and collaborate with resources
• Partner with leadership to improve quality and cost-effective service delivery
• May precept and coach clinical new hires, support onboarding, and assess competency/readiness
• Perform other duties as assigned
• Comply with all policies and standards

Executive Assistant – Office of CIO

LTSS Service Care Manager – Behavioral Health

Care Manager, Transition of Care (RN)

Senior RN LTSS Service Care Manager

Provider Engagement Account Manager

Senior Accountant – Brokerage, Member Incentives

Provider Engagement Account Manager

Senior Strategy Manager

Utilization Review Clinician – ABA

Senior LTSS Service Care Manager

Senior Actuarial Analyst – Medicare

Care Management Support Coordinator II – LTSS Medicaid Services

Care Coordinator III

Care Coordinator III

Senior RN, LTSS Service Care Manager