Centene Corporation

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

Product Manager

• Support product teams in offering quality, competitive product solutions for growth and retention of Ambetter marketplace members
• Support the annual Product Development Life Cycle for Commercial Marketplace products in all states
• Support design, build, and management of a competitive commercial product portfolio
• Ensure continued market relevance for commercial product portfolios to support short- and long-term growth planning
• Support development of commercial products and recommend initiatives to improve product performance
• Perform competitive intelligence, market analysis, industry assessment, and monitor internal business performance
• Utilize designated product tools to document, track, and reduce issues and errors
• Establish, document, and update processes for core and ancillary business requirements
• Lead intermediate projects and participate as a cross-functional team member
• Serve as product subject matter expert for assigned products or product elements
• Develop ongoing internal and external product trainings
• Ensure products align with federal and state regulatory requirements
• Support product-related regulatory filing efforts

Commercial Product Manager

Accountant

• Support cash-related accounting processes for Medicaid Health Plans
• Maintain accurate financial records
• Prepare monthly financial statements
• Participate in special projects
• Account for cash through cash deposits, cash applications, collection and cash forecasting
• Process payment and void requests
• Respond to inquiries about payments
• Assist with preparing financial reports and supporting month-end close processes
• Evaluate variances and account balances
• Analyze financial information detailing assets, liabilities and capital
• Perform other duties as assigned
• Comply with all policies and standards

Accountant I

Business Operations

• Independently lead complex programs comprised of multiple projects and workstreams
• Identify and mitigate risks proactively
• Manage interdependencies and drive alignment across diverse stakeholder groups
• Manage the full project life cycle, including requirements assessment, project plans and schedules, resources, budget, execution, deployment, and closure
• Use corporate and industry-standard project management tools and techniques
• Assist with establishing and maintaining corporate project management methodology and department procedures
• Maintain project documentation, including meeting minutes, action items, issues lists, and risk management plans
• Lead and communicate project status to stakeholders and external agencies
• Negotiate with stakeholders to identify resources, resolve issues, and mitigate risks
• Manage external vendor performance, governance, SLAs, KPIs, deliverables, escalations, remediation plans, and governance meetings
• Consider operational readiness, handoffs, controls, sustainability, and customer/member impact after implementation

Project Manager IV – Business Operations

Program Manager

• Plan and deliver strategic programs and complex, large-scale enterprise-wide projects
• Coordinate, provide visibility into, and manage key risks and dependencies
• Lead matrixed teams through complex integration initiatives
• Create and present executive-level program communications and facilitate cross-functional executive discussions
• Lead large-scale cross-functional implementation or process-improvement projects
• Oversee program scope, schedule, budget, timelines, and deliverables
• Coordinate project managers and business analysts across Operations, Finance, Benefit Operations, and other workgroups
• Create executive dashboards, project-status updates, and post-implementation analytics reports
• Deliver best-practice and training information and collaborate on training materials
• Prepare and deliver Steering Committee documents to the Executive team
• Assess and escalate program risks and issues
• Manage risk, budget/forecast, dependencies, and strategic business or operational analysis
• Serve as the first escalation point for project issues and risks and create mitigation plans
• Communicate business and technology issues and solutions

Program Manager IV

• Lead and support strategic initiatives and ongoing operational priorities across Member and Provider Services
• Coordinate cross-functional stakeholders, manage risks and dependencies, and drive timely execution
• Plan, organize, monitor, oversee, and lead multiple concurrent projects using cross-functional teams
• Identify opportunities to increase efficiency, improve service levels, and ensure regulatory compliance
• Develop strategies for improvement opportunities and align organizational priorities and resources
• Manage projects through the full project life cycle, including requirements gathering, project planning, scheduling, resourcing, budgeting, execution, deployment, and closure
• Use corporate and industry-standard project management tools and techniques
• Maintain project documentation, action items, issue lists, and risk mitigation plans
• Communicate project status to stakeholders through executive summaries and presentations
• Negotiate with stakeholders to secure resources, resolve issues, and mitigate risks
• Lead cross-functional meetings to meet stakeholder expectations and company objectives
• Provide functional and technical knowledge regarding program requirements and operations

Program Manager III

Advisor

• Establish and foster healthy working relationships between large physician practices, IPAs and Centene
• Educate providers on NCQA HEDIS measures and risk adjustment
• Support provider practice sites regarding HEDIS measures, medical record documentation and appropriate coding
• Assist in resolving deficiencies impacting plan compliance with State and Federal HEDIS and documentation standards
• Act as a resource for health plan peers on HEDIS measures, documentation and coding
• Support development and implementation of quality improvement interventions and provider-related audits
• Deliver, advise and educate provider practices and IPAs on HEDIS measures, documentation guidelines and HEDIS ICD-9/10 CPT coding
• Collect, summarize, trend and deliver provider quality and risk adjustment performance data
• Identify and strategize or coach on provider improvement and gap closure opportunities
• Collaborate with Provider Relations and other provider-facing teams to improve Quality, Risk Adjustment and Operations performance
• Identify practice needs where Centene can provide support
• Develop, enhance and maintain provider clinical relationships across product lines
• Maintain Quality KPIs and HEDIS abstraction accuracy rates according to corporate standards
• Comply with all policies and standards
• Perform other duties as assigned

Quality Practice Advisor

Account Manager

• Maintain partnerships between the health plan and contracted provider networks
• Build client relations to ensure delivery of the highest level of care to members
• Engage providers on network performance opportunities and solutions
• Provide consultative account management and accountability for issue resolution
• Drive optimal 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
• Respond to external provider-related issues
• Investigate, resolve, and communicate provider claim issues and changes
• Enter provider-related 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 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 all policies and standards

Provider Engagement Account Manager

• 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
• Provide consultative account management and accountability for issue resolution
• Drive performance in contract incentive performance, quality, and cost utilization
• Serve as primary provider contact and liaison with 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
• Enter provider demographic information changes
• Educate providers on referrals, claims submission, website usage, EDI solicitation, and related topics
• Conduct 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, Health Benefit Ratio, HEDIS/quality, cost, and utilization
• Complete special projects and other assigned duties
• Comply with policies and standards

Auditor

• Develop and implement effective business solutions through research, audit, and data and/or business-process analysis
• Audit and validate routine pre- and post-payment claims for correct adjudication and compliance
• Audit provider data loaded into claims processing systems
• Document and report audit results
• Research claims and enrollment discrepancies related to provider data
• Manage provider-data-management-related projects requiring advanced knowledge of provider files and their relationship to claims processing systems
• Review and support the claims process for medical review and cost-saving initiatives
• Maintain department statistics for quality improvement indicators, regulatory agencies and certification bodies
• Perform routine and moderately complex audits on medical review claims to identify exceptions
• Research reviewed-claim issues to determine origins and appropriate resolutions
• Summarize findings and recommendations in reports and distribute them to management
• Communicate audit and review results to the claims department to improve claims processing and resolutions
• Provide qualified data for training programs, policies and procedures
• Maintain current working knowledge of Health Net products, policies, procedures, coding, and applicable industry standards

Senior Quality Auditor

People Operations

• Serve as a trusted advisor to leaders and employees across the enterprise
• Provide guidance and support on workplace matters
• Manage employee relations cases from intake through resolution, including formal disciplinary action up to and including termination
• Advise employees and managers on policy interpretation, conflict resolution, performance management, progressive discipline, and termination processes
• Partner with HR Business Partners, HR Centers of Expertise, internal and external legal counsel, and other investigative bodies
• Use the case management system to track and manage employee matters to resolution
• Interpret and apply company policies, employment laws, and regulations
• Perform other duties as assigned
• Comply with all policies and standards

People Relations Partner

Care Navigator

• Develop, assess, and coordinate care management activities based on member needs
• Develop or contribute to personalized care plans/service plans
• Educate members and families/caregivers on services, benefit options, procedures, care options, referrals, and healthcare benefits
• Evaluate member needs, barriers to care, available resources, and facilitate plans for best outcomes
• Identify providers, specialists, and community resources needed for care
• Provide psychosocial and resource support to members/caregivers and care managers
• Coordinate between members/families/caregivers and care provider teams to ensure timely access to services
• Monitor progress toward care plan goals and member status or changes in condition
• Collaborate with healthcare providers on care plan revisions and refer members for further care management evaluation when appropriate
• Collect, document, and maintain member information and care management activities for regulatory compliance
• May perform on-site visits to assess member needs and collaborate with providers or resources
• Perform other duties as assigned and comply with all policies and standards

Care Navigator – Foster Care

Compliance

• Support strategies to ensure successful maintenance and implementation of compliance programs meeting regulatory requirements for assigned products across the company
• Monitor state regulations, contract amendments, executive action, rulemaking, and other regulatory guidance
• Notify stakeholders of regulatory changes
• Maintain and track laws, regulations, and compliance guidance documents
• Review and synthesize regulatory requirements
• Prepare regular updates, white papers, and reporting on impactful regulatory actions
• Collaborate with Policy, Government Relations, Legal, and other departments to assess and analyze impactful regulations and guidance
• Support implementation oversight of new compliance requirements with respect to regulatory language

Senior Compliance Analyst – Regulatory Change Management

Implementation Specialist

• Guide the strategic product direction for the department
• Own product road maps, development and implementation, opportunity identification, business case development, industry research, and new product introduction
• Govern multiple products end-to-end from concept to production at a global level
• Align stakeholders on complex business needs into a global product strategy
• Translate business strategy into product strategy and roadmaps by facilitating collaboration between business leaders and technology teams
• Manage the overall lifecycle of multiple enterprise-wide products, including design, development, implementation, and support
• Ensure ongoing funding and investment of product development and measure efficiencies, value realized, and ROI
• Monitor and coach the agile development process to promote productivity, efficiency, and team engagement
• Collaborate with and influence senior leadership and technology teams on new and existing systems and practices
• Integrate market changes and technology improvements into actionable product improvements
• Partner with internal and external stakeholders to provide a global viewpoint and extend applications across use cases
• Drive cyclical processes covering business value, financial review, forecasting, idea generation, opportunity sizing, business cases, development, and implementation
• Perform other duties as assigned

Senior Director, Product Implementation

Assessor

• Perform care management duties for complex/high-acuity populations with primary medical/physical health needs
• Conduct UAS Assessments for the MLTC member population with Fidelis
• Evaluate service needs and recommend plans for optimal outcomes
• Develop and continuously assess long-term care and service plans
• Collaborate with care management teams to identify providers, specialists, and community resources
• Coordinate with members, families/caregivers, and care provider teams to ensure person-centered care
• Monitor member status, complications, symptoms, care-plan progress, and changes in condition
• Review member data, referrals, and intake assessments to improve care quality and operating performance
• Collaborate with healthcare providers to facilitate services and treatments and revise care plans
• Collect, document, and maintain member information and care management activities
• Educate members and families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits
• Act as liaison and advocate among members, families, physicians, facilities, and agencies
• Coordinate community resources and service authorizations for services such as meals, employment, housing, foster care, transportation, and activities of daily living
• Perform home and/or other site visits as required
• Partner with leadership to improve quality of care and cost-effective service delivery
• May precept and coach clinical new hires, support onboarding, and assess competency readiness
• Perform other duties as assigned and comply with all policies and standards

Supervisor, Care Management – LTSS

Commercial Product Manager

Accountant I

Project Manager IV – Business Operations

Program Manager IV

Program Manager III

Quality Practice Advisor

Provider Engagement Account Manager

Provider Engagement Account Manager

Senior Quality Auditor

People Relations Partner

Care Navigator – Foster Care

Senior Compliance Analyst – Regulatory Change Management

Senior Director, Product Implementation

Senior UAS LTSS Assessor, RN