Centene Corporation

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

Bookkeeper

• Apply all cash receipts and payments received using the appropriate systems and databases
• Enter manual billing information
• Update Accounts Payable check requests logs
• Analyze aging activity, accounts receivable credits, days sales outstanding, and cash-to-revenue reports
• Assist with semi-monthly billing
• Support major company functions including Accounts Payable and Billing

Accounting Assistant

Advisor

• Establish and foster working relationships between large physician practices, IPAs, and Centene
• Educate providers and support provider practice sites regarding NCQA HEDIS measures and risk adjustment
• Provide education on HEDIS measures, medical record documentation, and coding
• Assist in resolving deficiencies affecting plan compliance with state and federal HEDIS and documentation standards
• Serve as a resource for health plan peers
• 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 on provider improvement and gap closure opportunities
• Collaborate with Provider Relations and other provider-facing teams
• 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 standards
• Comply with all policies and standards
• Perform other duties as assigned

Quality Practice Advisor

• Apply all cash receipts and payments received using appropriate systems and databases
• Assist major company functions including Accounts Payable and Billing
• Enter manual billing information
• Update Accounts Payable check requests logs
• Analyze aging activity, accounts receivable credits, days sales outstanding, and cash to revenue reports
• Assist with semi-monthly billing
• Candidates residing in the Tampa area may attend onsite training and work onsite
• Candidates outside the Tampa area will not be required to commute to the office

Clinical Coordinator

• Act as liaison for statewide appeals, fair hearings, review organizations, and other external appeals
• Ensure appeal letters comply with State and NCQA requirements
• Review clinical information for appeals using nationally recognized criteria to determine medical necessity
• Prepare reviews for cases that do not meet criteria
• Gather, analyze, and report information regarding member and provider clinical appeals, including follow-up
• Prepare response letters for member and provider clinical appeals
• Maintain files and logs for all appeals
• Coordinate with Medical Directors to clarify medical determinations or clinical rationale
• Maintain current knowledge of NCQA and State regulations
• Coordinate Fair Hearings with internal departments and agencies
• Perform other assigned duties and comply with policies and standards

Clinical Appeals Coordinator

Actuary

• Conduct analysis, pricing, and risk assessment to estimate financial outcomes
• Support the Risk Adjustment team through data analytics, risk adjustment modeling, and complex data validation initiatives
• Run and analyze market-level results using CDPS+RX or similar risk adjustment models
• Act as the team’s point of contact for an assigned group of markets
• Apply mathematics, probability, statistics, finance, and business principles to calculate financial outcomes
• Develop probability tables based on statistical data and other pertinent information
• Determine equitable bases for distributing money for insurance benefits
• Translate complex analyses into actionable business insights
• Perform other duties as assigned and comply with company policies and standards

Senior Actuary

Account Executive

• Develop and maintain strategic partnerships between the health plan and contracted provider networks
• Advance value-based care initiatives, improve provider performance, and enhance member outcomes
• Serve as a trusted advisor to providers and internal stakeholders through data-driven insights, operational support, and performance improvement strategies
• Serve as primary strategic partner and point of contact for hospital systems, multispecialty groups, and large primary care organizations
• Provide guidance on value-based program design, reporting tools, performance metrics, and financial methodologies
• Deliver training, education, and ongoing support on value-based programs, reporting, and operational processes
• Manage and maintain the value-based payment contract portfolio, resolve operational issues, correct data discrepancies, and support payment execution
• Analyze complex datasets using Excel, dashboards, and reporting tools
• Develop executive-level presentations translating provider performance data into actionable insights and recommendations
• Drive process improvement initiatives, operational efficiencies, and best-practice playbooks
• Execute provider performance improvement strategies across quality, pay-for-performance, cost, and utilization initiatives
• Build and maintain relationships with provider leaders, executive stakeholders, and cross-functional internal teams
• Support contracting strategy with insights on provider relationships, market dynamics, and organizational considerations
• Review, interpret, and apply value-based and provider contract language
• Educate providers on policies, procedures, claims submission requirements, referral processes, EDI capabilities, and provider portal tools
• Provide leadership, guidance, and mentorship to provider-facing team members and external partners
• Resolve provider issues and create efficiencies to prevent recurring concerns
• Perform other duties as assigned

Provider Engagement Account Executive

Trainer

• Conduct training needs analyses for Pharmacy Services staff and evaluate effectiveness
• Identify, develop, and conduct training programs
• Select and design appropriate training aids
• Facilitate the train-the-trainer process for various systems
• Research, analyze, and recommend external training programs
• Maintain records of training activities and employee progress
• Audit work and coordinate training initiatives
• Identify, develop, and publish corrective actions and educational materials
• Provide feedback on policy and procedure revisions and work process development
• Perform other duties as assigned
• Comply with all policies and standards

Trainer II

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, care options, referrals, healthcare benefits, and provider instructions
• Evaluate member needs, barriers to care, available resources, and recommend/facilitate plans
• Identify providers, specialists, and community resources needed for care
• Provide psychosocial and resource support for employment, education, housing, food, participant direction, independent living, justice, and foster care needs
• Coordinate between members/families/caregivers and care provider teams to ensure timely access to care and 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
• Collect, document, and maintain member information and care management activities for regulatory compliance
• Perform on-site visits as appropriate to assess member needs and collaborate with providers/resources
• Perform other assigned duties and comply with policies and standards

Care Navigator – Foster Care

• Develop and conduct training programs and/or auditing tools for Centene's Pharmacy Services
• Develop full training programs including content, agendas, activities, and assessments
• Conduct training needs analyses for Pharmacy Services staff and evaluate effectiveness
• Identify, develop, and conduct training programs
• Select and design appropriate training aids
• Facilitate the train-the-trainer process for various systems
• Research, analyze, and recommend external training programs
• Maintain records of training activities and employee progress
• Audit work and coordinate training initiatives
• Develop and publish corrective actions and educational materials
• Provide feedback on policy, procedure, and work process revisions
• Perform other duties as assigned

• Develop, assess, and facilitate complex care management activities for members with primarily physical needs
• Create personalized care plans and educate members and families
• Evaluate member needs, access barriers, and social determinants of health
• Develop ongoing care/service plans and collaborate with providers, specialists, and community resources
• Identify care barriers and provide care management interventions
• Coordinate person-centered care among members, caregivers, and provider teams
• Follow up and monitor member status, condition changes, and care-plan progress
• Provide local resource support for services including employment, housing, participant direction, independent living, justice, and foster care
• Facilitate 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 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 policies and standards

Care Coordinator

• Support care management activities and assigned member teams to ensure provider services, continuity of care, and member satisfaction
• Conduct member outreach by telephone and home visits
• Discuss care plans/service plans, next steps, resources, questions, concerns, and ongoing education
• Coordinate care activities with healthcare and community providers, partners, members, and caregivers
• Support member and provider inquiries, requests, and concerns
• Communicate with care managers, practitioners, and others to facilitate member services
• Support service assessments and screenings and document member care needs
• 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 on available benefits and resources
• Comply with policies, standards, contractual requirements, and regulatory guidelines
• Perform other duties as assigned

Care Coordinator II

General

• Independently evaluate and interpret Payment Integrity policies, federal and state regulatory changes, contract updates, and internal program changes affecting claims adjudication and configuration operations
• Analyze new and updated Payment Integrity payment policies, including pre-pay and post-pay program requirements, national guidelines, and internal PI operating models
• Review federal and state regulatory changes, bulletins, and payer requirements to determine applicability to claims processing and required customizations
• Interpret contractual provisions to support accurate benefit, payment, and policy logic within claims workflows
• Evaluate policy changes for operational feasibility and claims system impact, including configuration, testing, production readiness, and downstream workflows
• Collaborate with Claims and Configuration Operations to validate rule interpretations and support accurate, consistent adjudication outcomes
• Partner with PI Leadership, Medical Affairs, Coding, Compliance, vendor partners, health plans, and related teams on end-to-end policy implementation
• Develop policy summaries, decision documentation, operational guidance, and implementation notes
• Contribute to provider education content when policy changes require external communication
• Perform other duties as assigned and comply with all policies and standards

Payment Integrity Policy Specialist II

Operations

• Oversee operations and business strategy using cross-functional departments to meet strategic objectives
• Develop and manage methodologies for tracking, identifying and solving problems
• Interpret and present program results and insights
• Develop data-driven analysis approaches for clients
• Perform data analysis from varied data sources
• Evolve metrics used to measure effectiveness and return on investment of product activity
• Collaborate with staff to identify internal and external customers and their expectations
• Initiate process changes to increase quality, decrease costs, and improve staff, provider, and member satisfaction
• Facilitate and support operations staff in planning, achieving, and tracking strategic initiatives
• Serve as an internal resource and advisor on improvement activities
• Explore new work-process approaches using quality-improvement techniques to eliminate waste and rework

Operations Manager

• Review and analyze complex contact center operational processes
• Provide data-driven insights related to operational targets, best practices, and training programs
• Gather, analyze, and interpret contact center data and operational processes to identify risk areas
• Prepare reports for management and senior leadership
• Support development and implementation of strategic business solutions through research and data or business-process analysis
• Identify operational improvement opportunities and recommendations for remediation
• Prepare financial and quality impact analyses and final reports
• Analyze operational process inefficiencies and develop improvement opportunities
• Notify contact center operations users about business system defects and issues and provide short-term resolutions
• Develop and maintain dashboards assessing contact center performance against enterprise objectives
• Support implementation of desktop procedure documentation for best practices, policies, and standards
• Provide materials and insights for ongoing contact center training programs
• Perform other duties as assigned

Care Manager, RN

Accounting Assistant

Quality Practice Advisor

Accounting Assistant

Clinical Appeals Coordinator

Senior Actuary

Provider Engagement Account Executive

Trainer II

Care Navigator – Foster Care

Trainer II

Care Manager, RN

Care Coordinator II

Payment Integrity Policy Specialist II

Operations Manager

Operations Analyst II