Centene Corporation

Operations

• 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

Operations Analyst II

• Drive the review and analysis of 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 and prepare management reports
• Support development and implementation of strategic business solutions through data and business process research and analysis
• Identify operational improvement opportunities and recommendations for remediation, including financial and quality impact analysis
• Analyze operational data insights and identify opportunities for operational improvements
• Assist with analyzing process inefficiencies and developing contact center process improvements
• Notify 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 insight for ongoing contact center training programs
• Perform other duties as assigned

• Review and analyze complex contact center operational processes
• Provide data-driven insights related to operational targets, best practices, and training programs
• Work with team members and stakeholders to develop contact center process improvements
• Gather, analyze, and interpret contact center data and operational processes
• Identify risk areas and 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 data insights and identify improvement opportunities
• Analyze process inefficiencies and develop improvement opportunities
• Notify operations users about business system defects and issues and provide short-term resolutions
• Develop and maintain dashboards measuring contact center performance against enterprise objectives
• Support desktop procedure documentation for best practices, policies, and standards
• Provide materials and insight for ongoing contact center training programs
• Perform other assigned duties

Manager

• Assess, plan, and implement complex care management activities
• Develop personalized care plans/service plans for members
• Continuously assess care plans and collaborate with providers and community resources
• Coordinate members, families/caregivers, and care provider teams to ensure person-centered care
• Monitor member status, condition changes, and progress toward care goals
• Identify barriers and interventions for escalated cases
• Review member data, referrals, and intake assessments to improve care quality and operating performance
• Perform telephonic, digital, home, and other site outreach
• Collaborate with healthcare providers to facilitate services and treatments
• Document member information and care management activities for regulatory compliance
• Educate members and caregivers on disease processes, care gaps, referrals, care options, and benefits
• Partner with leadership to improve cost-effective care delivery
• Precept and coach clinical new hires during onboarding
• Guide preceptees within a Managed Care Organization and provide coaching/shadowing
• Complete competency checkpoints and monitor readiness for Service Coordination
• Collaborate with People Leaders and cross-functional teams to measure readiness
• Perform other assigned duties and comply with policies and standards

Senior Care Manager, RN

• Develop, assess, and facilitate complex care management activities for primarily mental and behavioral health needs
• Provide high-quality, cost-effective healthcare outcomes through personalized care plans and education
• Evaluate member needs via phone or in-home visits and recommend or facilitate care/service plans
• Conduct telephonic, digital, home, and/or 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 care or services
• 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 care quality and cost-effectiveness
• Comply with all policies and standards
• Perform other duties as assigned

Care Manager

Business Analyst

• Perform provider data management activities based on plan and contract specifications and standard business rules
• Analyze and enter data
• Review data via internet sites and other systems
• Use multiple systems and applications to validate data completeness and accuracy
• Manage provider enrollment and data updates
• Ensure claims and provider directory accuracy
• Resolve system issues through research and quality checks
• Enroll providers and practitioners into the provider data management system
• Update provider and practitioners with claims payment and directory information
• Research, review, and update the provider data management system per provider requests
• Perform quality service checks on systemic data, including claims processing and provider directory information
• Research and resolve problems as necessary

Provider Data Management Analyst I

Accountant

• Maintain cash balances daily and reconcile bank accounts monthly
• Reconcile general ledger accounts
• Analyze financial data and support accurate financial reporting
• Prepare and reconcile month-end close files, including researching and resolving discrepancies
• Process and review accounts payable submissions and support check generation
• Provide audit assistance on financial, regulatory, and health plan audits
• Roll forward close files and support preparation for future accounting cycles
• Perform other duties as assigned
• Support accounting operations through financial reporting, reconciliations, account analysis, and month-end close activities
• Ensure accuracy, compliance, and timely completion of accounting processes

Accountant II

Director

• Provide strategic and operational insights to senior leadership to drive key initiatives and growth plans in the market
• Collaborate with Corporate Strategy partners to align with broader organizational initiatives
• Gather information and initiate action plans on topics, issues and projects impacting operations and strategic initiatives
• Collaborate with senior leadership to achieve business objectives
• Coordinate with leadership team members to update projects and initiatives at leadership team meetings
• Act as the President’s liaison to market teams and corporate departments
• Represent the President’s plans and actions
• Identify impacts, risks and interdependencies and support development and monitoring of actions and integration activities
• Oversee development of the President’s internal and external meeting materials
• Manage special projects or committees assigned by the Plan President or COO
• Support strategy, planning and business development activities, including meetings, requests for information and presentations
• Lead planning and development of Business Review presentations with the leadership team
• Coordinate with the CFO to plan and develop the Annual Operating Plan and related forecasting overview materials for the market

Director – Health Plan Programs and Initiatives

• Oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance
• Lead a team supporting the credentialing and provider data management organization from a technical perspective
• Manage system updates and enhancements, data analysis, and reporting
• Provide direct oversight for credentialing and re-credentialing of physicians, mid-level practitioners, and organizational providers
• Oversee provider data management activities, including training materials, policies, and procedures
• Ensure provider record updates comply with health plan policies and state/federal regulations
• Ensure compliance with corporate KPIs, NCQA credentialing standards, and state/federal requirements
• Manage production and updates of hard copy and online provider directories
• Ensure accuracy of provider enrollment specifications, specialty types, and demographics

Senior Manager, Credentialing – Provider Data Management Systems

• Document how Enterprise Learning teams currently evaluate and report learning effectiveness
• Survey learning teams and administer a survey
• Organize responses and reporting examples into common themes
• Partner with Enterprise Analytics Solutions to understand available capabilities
• Connect current practices to evaluation approaches, including Kirkpatrick where appropriate
• Create an executive-ready presentation or visual resource
• Learn processes and functions within the Managed Care industry
• Contribute to projects supporting the business
• Apply academic knowledge and learn new skills through projects
• 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

Learning Reporting and Evaluation Business Analyst Intern – Undergraduate, Summer

Nurse

• 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 and healthcare benefits
• Evaluate member needs, barriers to care and available resources; recommend and facilitate appropriate plans
• Identify providers, specialists and community resources needed for care
• Provide psychosocial and resource support regarding employment, education, housing, food, participant direction, independent living, justice and foster care
• Coordinate among 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 to revise care plans and address member needs
• 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 duties assigned by the people leader and comply with policies and standards

Care Navigator, LPN/LVN

Medical Director

• Assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities
• Perform medical reviews for utilization review, quality assurance, and complex, controversial, or experimental medical services
• Support performance improvement initiatives for capitated providers
• Assist in establishing goals and policies to improve quality and cost-effectiveness of care and services
• Provide medical expertise for quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements
• Assist with physician committee structure, processes, and membership
• Conduct regular rounds for high-risk patients and collaborate with care management teams
• Collaborate with clinical teams, network providers, appeals teams, and medical and pharmacy consultants on complex cases and medical necessity appeals
• Participate in provider network development and new market expansion
• Assist with physician education on clinical issues and policies
• Identify utilization review studies and evaluate adverse utilization trends, unusual provider practice patterns, and benefit/payment adequacy
• Identify clinical quality improvement studies to reduce unwarranted variation and improve quality and cost of care
• Interface with physicians and providers to implement recommendations improving utilization and healthcare quality
• Review complex, controversial, unusual, or new-service claims to determine medical necessity and appropriate payment
• Develop provider-community alliances through medical management programs
• Represent the business unit before local and national publics on medical philosophy, policies, and related issues as needed
• Represent the business unit at state and ad hoc committees
• Work weekends and holidays as needed to support business operations

Medical Director, Pharmacy

Financial Planning and Analysis

• Analyze complex financial information and translate data into meaningful insights that support business decisions
• Independently lead financial projects and initiatives
• Partner with stakeholders to drive financial performance and organizational goals
• Develop integrated revenue/expense analyses, projections, reports, and presentations
• Create and analyze monthly, quarterly, and annual reports and ensure financial information has been recorded accurately
• Identify trends and developments in competitive environments and present findings to senior management
• Perform financial forecasting and reconciliation of internal accounts
• Handle complex and high-level financial analysis
• Present and discuss analysis with upper management

Finance Analyst III – Managed Care

Quality Specialist

• Take a lead role in developing and maintaining quality improvement projects specific to HEDIS Hybrid Operations
• Serve as primary owner for assigned HEDIS measures
• Train providers, health plans, and staff in continuous quality improvement methodologies and tools, HEDIS abstraction, and over-read processes
• Provide clinical support to medical record abstraction, over-read, and audit processes
• Monitor performance on established contractual quality indicators
• Analyze, track, and trend results
• Prepare for and participate in meetings with committees, state agencies, providers, health plans, vendors, and stakeholders
• Recommend, develop, and implement quality performance improvement plans (PIPs) with management using the PDSA model
• Monitor and report PIP progress through closure
• Conduct year-round pseudo-claims performance, gap identification, and intervention and strategy planning for assigned HEDIS measures
• Support department leadership in project and strategy development
• Lead complex or high-risk HEDIS quality improvement initiatives with market-wide impact
• Provide guidance on complex abstraction scenarios, team training, measure interpretation, abstraction standards, and quality improvement best practices
• Mentor and serve as a resource to team members
• Perform other duties as assigned
• Comply with all policies and standards

Quality Improvement Specialist – HEDIS II

Supervisor

• Supervise Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team
• Supervise day-to-day activities of the utilization management team
• Monitor and track UM resources for performance, compliance, quality, and efficiency
• Collaborate with the utilization management team to resolve complex care member issues
• Maintain knowledge of utilization management regulations, accreditation standards, and industry best practices
• Identify process and quality improvement opportunities with the utilization management team and senior management
• Educate and provide resources to the utilization management team
• Monitor clinical review nurses and ensure compliance with applicable guidelines, policies, and procedures
• Develop and implement UM policies, procedures, and guidelines with senior management
• Evaluate team performance and provide feedback on performance, goals, and career milestones
• Coach and guide the utilization management team
• Assist with onboarding, hiring, and training team members
• Lead and champion change within scope of responsibility
• Perform other duties as assigned
• Comply with all policies and standards

Operations Analyst II

Operations Analyst II

Operations Analyst II

Senior Care Manager, RN

Care Manager

Provider Data Management Analyst I

Accountant II

Director – Health Plan Programs and Initiatives

Senior Manager, Credentialing – Provider Data Management Systems

Learning Reporting and Evaluation Business Analyst Intern – Undergraduate, Summer

Care Navigator, LPN/LVN

Medical Director, Pharmacy

Finance Analyst III – Managed Care

Quality Improvement Specialist – HEDIS II

Supervisor, Utilization Management – RN