Centene Corporation

Care Coordinator

• Support care management activities and assigned member teams
• Perform member outreach by telephone and through home visits
• Document care/service plans and related activities
• Discuss care plans, next steps, resources, questions, concerns, and ongoing education with members
• Coordinate care activities with healthcare providers, community providers, partners, members, and caregivers
• Respond to member and provider inquiries, requests, and concerns
• Communicate with care managers, practitioners, and others to facilitate member services and continuity of care
• Support service assessments and screenings and document member care needs
• Maintain member records in accordance with state and regulatory requirements
• Identify needs and make referrals to Care Managers, community-based organizations, and Disease Managers
• Educate members about available benefits and resources
• Perform other duties as assigned

Care Coordinator II

• Support care management activities and assigned member teams
• Ensure services are delivered by healthcare providers and partners
• Conduct member outreach by telephone or home visits
• Document care/service plans and related activities
• Coordinate care activities with healthcare providers, community partners, members, and caregivers
• Respond to member and provider inquiries, requests, and concerns
• Communicate with care managers, practitioners, and others to facilitate member services and continuity of care
• Support service assessments and screenings
• Maintain member records in accordance with state and regulatory requirements
• Identify needs and make referrals to Care Managers, community-based organizations, and Disease Managers
• Educate members about available benefits and resources
• Perform other assigned duties and comply with policies and standards

• Perform outreach to 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
• 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
• Document and maintain non-clinical member records in accordance with state and regulatory requirements
• Provide records to providers as needed
• Make referrals addressing Social Determinants of Health needs
• Comply with all policies and standards
• Perform other duties as assigned

Care Management Support Coordinator II

Director

• Drive development of multi-year, market-specific Medicare Stars performance strategy
• Plan and partner with stakeholders to understand geographic market expansion of the Medicare business
• Research and plan innovations for the Medicare Stars Program
• Direct the annual Medicare multi-year strategic planning process
• Develop recommendations for new state and county expansion markets
• Build cross-functional relationships to implement business strategies
• Oversee network and sales channel development for new state expansions
• Leverage Medicare product strategy to enhance go-to-market strategy across sales, marketing, and markets
• Work with product development to oversee implementation of new innovations
• Facilitate exploration of external partnerships to enhance Medicare strategic positioning
• Support financial, sales, and operational reporting and analysis
• Perform other duties as assigned

Director – Quality Medicare Strategy

Manager

• Develop, assess, and coordinate holistic care management activities for long-term care members
• Develop or assist with personalized service care plans/service plans
• Educate members and families/caregivers about available services and benefits
• Evaluate member needs and available resources; recommend or facilitate appropriate plans
• Identify providers, specialists, and community resources for long-term care
• Coordinate between members, families/caregivers, and care provider teams
• Provide resource support for employment, housing, participant direction, independent living, justice, and foster care needs
• Monitor care plans, member status, and outcomes; recommend updates based on needs
• Interact with long-term care healthcare providers and partners
• Collect, document, and maintain member information and care management activities for regulatory compliance
• Perform home and other site visits as needed
• Facilitate education on procedures, provider instructions, service options, referrals, and healthcare benefits
• Provide leadership feedback on quality of care and cost-effective service delivery
• Perform other duties as assigned

LTSS Service Care Manager

• Manage operations of credentialing and provider data management functions for multiple business units
• Oversee credentialing and re-credentialing of physicians, mid-level practitioners and organizational providers
• Oversee provider setup processes for claims payment, member assignment and directory display
• Ensure compliance with NCQA and DHHS credentialing requirements
• Participate in activities related to plan NCQA accreditation
• Collaborate with health plans and departments on network expansion, large claims, contract amendment projects and related initiatives
• Identify process improvement opportunities to decrease cost, improve quality and increase efficiency
• Review and update departmental policies and procedures for compliance with NCQA, CMS and other regulatory agencies
• Monitor Medicaid and Medicare sanctioning reports for compliance with HCFA requirements
• Facilitate Credentialing Committee activities
• Serve on Quality Improvement Committees when needed

Manager, Provider Data Management – Credentialing

Account Manager

• Act as a liaison with vendors and internal business partners to build continuous relationships and understand business requirements, needs, and service expectations
• Work alongside vendor management team members to maintain complex vendor relationships and enhance vendor experience
• Communicate with vendors to ensure member or provider satisfaction and performance
• Assess key performance data to monitor and measure productivity and program compliance
• Build reports using performance data to identify process improvement areas
• Liaise between internal departments and vendors to handle escalations, such as claims
• Facilitate new business and process implementations from initial launch through day-to-day interactions
• Seek new business opportunities with vendors to create collaborative relationships supporting compliance
• Perform root cause analyses with vendors to identify business issues and problems
• Liaise with workforce management and training teams to schedule and support vendor training
• Work directly with vendors on training, planned maintenance, and other services to educate them and provide product/service updates
• Perform other duties as assigned

Account Relations Manager II

• 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 ongoing care plans and collaborate with providers, specialists, and community resources
• Identify problems and barriers to care and provide care management interventions
• Coordinate between members, families/caregivers, and care provider teams
• Monitor member status, changes in condition, and progress toward care plan goals; revise plans 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 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
• Comply with all policies and standards and perform other assigned duties

Care Manager, RN – OB

Risk

• Provide executive leadership for risk adjustment performance across markets and lines of business
• Serve as the primary liaison between Enterprise Risk Adjustment and market leadership
• Lead market risk adjustment strategies and initiatives to achieve enterprise performance objectives
• Establish and monitor targets for risk score capture, coding accuracy, documentation quality, chart retrieval, and provider performance
• Identify and prioritize high-impact provider organizations and strategic partners
• Build executive-level relationships with provider organizations and integrate risk adjustment priorities into value-based care and population health strategies
• Direct collaboration across risk adjustment, provider engagement, quality, network management, actuarial, clinical operations, analytics, and external partners
• Establish governance, accountability frameworks, and performance review processes
• Develop executive reporting, dashboards, and action plans to measure results and address performance gaps
• Conduct risk assessments, root-cause analyses, and targeted interventions
• Advise enterprise and market leadership on provider investments, resource allocation, operating model enhancements, and best practices
• Perform other duties as assigned
• Comply with all policies and standards

Senior Director, Risk Adjustment Market Performance

• Support care management activities and assigned member teams
• Ensure services are delivered by healthcare providers and partners
• Interact with members through telephone outreach and home visits
• Document care and service activity plans
• Discuss care plans, next steps, resources, questions, and concerns with members
• Coordinate care activities with healthcare and community providers, partners, members, and caregivers
• Respond to member and provider inquiries and concerns
• Communicate with care managers, practitioners, and others to facilitate member services and continuity of care
• Support service assessments and screenings
• Document and maintain member records and distribute them to providers as needed
• Identify needs and make referrals to Care Managers, community-based organizations, and Disease Managers
• Provide education about available benefits and resources
• Perform other assigned duties and comply with policies and standards

Care Coordinator II, Foster Care

Program Manager

• Develop and implement long-range behavioral health program strategies
• Manage projects and initiatives focused on internal and external behavioral health integration
• Direct and facilitate behavioral health clinical training programs for associates and providers
• Assist with behavioral health program and service development, including policies, procedures, clinical criteria, workflows, documentation, and product development
• Lead behavioral health and behavioral health home program development and integration activities
• Drive cross-functional initiatives to improve behavioral health product quality
• Use data to identify and manage change for performance improvement
• Communicate and educate associates on behavioral health strategy
• Develop clinical educational materials and provide behavioral health education to providers
• Develop and enhance relationships with behavioral health homes, community mental health centers, hospitals, individual providers, and participating groups
• Design, develop, and implement behavioral health clinical training for associates and providers
• Work with utilization, case, and disease management teams to operationalize behavioral health/physical health integration initiatives
• Educate health plan leadership and cross-functional staff on behavioral health and integration strategy
• Produce presentations and training materials for providers and associates
• Manage behavioral health policy and procedure development, clinical program descriptions, and related documentation
• Assist with behavioral health provider and home provider audits
• Analyze behavioral health utilization data and monitor KPIs and utilization management metrics
• Participate in corrective action plans and improvement activities
• Assist behavioral health home candidates preparing for NCQA Patient-Centered Specialty Practice (PCSP) recognition
• Oversee compliance with behavioral health home contracts and standards
• Perform other assigned duties

Behavioral Health Program Manager

• Develop, assess, and facilitate complex care management activities for members with primarily physical needs
• Create personalized care plans and provide education to members and families
• Evaluate member needs, barriers to care, and social determinants of health
• Develop ongoing care/service plans and collaborate with providers, specialists, and community resources
• Identify care barriers and provide appropriate interventions
• Coordinate person-centered care among members, caregivers, and provider teams
• Monitor member status, conditions, and progress toward care-plan goals; revise plans as needed
• Provide resource support for local services including employment, housing, independent living, justice, and foster care
• Facilitate timely access to needed care and services
• Conduct telephonic, digital, home, and other site outreach
• Document member information and care-management activities for regulatory compliance
• Educate members and caregivers on disease processes, care gaps, provider instructions, care options, referrals, and 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

Designer

• Design, implement, and maintain training resources
• Write, update, evaluate, and propose training programs supporting customer service, technical process documentation, operational systems, and e-learning development
• Design instructional materials supporting learning and performance within Quality department functional teams
• Outline and deliver timely training project plans
• Maintain training resources and support sites
• Develop instruments to assess changes in knowledge, skills, and quality results
• Review training program objectives and assess the need for content and structure modifications
• Facilitate training as needed to support operational goals
• Perform other duties as assigned
• Comply with all policies and standards

Curriculum Designer

Business Analyst

• Perform analysis and interpretation to link business needs and objectives for the assigned function
• Support business initiatives through data analysis, identification of implementation barriers, and user acceptance testing of systems
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Perform detailed analysis on multiple projects, recommend potential business solutions, and ensure successful implementations
• Identify ways to enhance performance management and operational reports related to new business implementation processes
• Coordinate with business units and departments in developing and delivering training programs
• Develop, share, and incorporate organizational best practices into business applications
• Diagnose problems and identify opportunities for process redesign and improvement
• Formulate and update departmental policies and procedures
• Serve as subject matter expert on the assigned function product to ensure operational performance
• Comply with all policies and standards

Business Analyst III – Contact Center Operations

• Develop, assess, and facilitate complex care management activities for primarily physical-needs members
• Evaluate member needs, barriers to appropriate care, and social determinants of health
• Develop ongoing care plans/service 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 to ensure person-centered care
• Follow up and monitor member status, changes in condition, and progress toward care-plan goals
• Provide resource support for employment, housing, participant direction, independent living, justice, foster care, and other services
• Facilitate care management and timely access to needed care or 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 all policies and standards