Centene Corporation

Business Process Consultant

Centene Corporation · Full Time · 2 hours ago

Centene Corporation

🌎 United States 💵 $70100 - $126K per year ⭐ 5-10 yrs exp 💼 Others

The Business Process Consultant leads large-scale, cross-functional initiatives to optimize business unit performance and drive financial gains. This includes developing business cases, designing end-to-end processes, and managing project teams to ensure effective implementation.

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Clinical Extern

Centene Corporation · Full Time · 2 hours ago

Centene Corporation

🌎 United States ⭐ 0-2 yrs exp 💼 Healthcare

Observe preceptors and participate in various projects to develop skills within the Managed Care industry. Gain hands-on experience by shadowing clinical services and following company guidelines.

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Authorization Specialist I

Centene Corporation · Full Time · 3 hours ago

Centene Corporation

🌎 United States 💵 $16.35 - $23.46 per hour ⭐ 0-2 yrs exp 💼 Others

Supports the prior authorization process by documenting medical information and ensuring requests are addressed within contractual timelines. Maintains and updates authorization requests within the utilization management system to ensure member healthcare access.

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SIU Investigator

Centene Corporation · Full Time · 5 hours ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 0-2 yrs exp 💼 Others

Investigate allegations of healthcare fraud, waste, and abuse through claims audits and data mining. Prepare detailed investigative reports for referral to state and federal agencies.

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Workforce Scheduling Analyst II

Centene Corporation · Full Time · a day ago

Centene Corporation

🌎 United States 💵 $27.02 - $48.55 per hour ⭐ 2-5 yrs exp 💼 Others

Analyzes contact center workloads to build resourcing and optimize scheduling plans to meet business goals. Evaluates key performance metrics and productivity to provide data-driven recommendations for operational improvement.

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Data Analyst I Healthcare Analytics

Centene Corporation · Full Time · a day ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 0-2 yrs exp 💼 Software Development

Analyze extensive healthcare datasets to extract value and influence business decisions to reduce cost of care and improve clinical outcomes. Collaborate with stakeholders to identify value areas, perform root-cause analysis on data irregularities, and communicate insights to non-technical partners.

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Project Manager IV

Centene Corporation · Full Time · a day ago

Centene Corporation

🌎 United States 💵 $87700 - $157K per year ⭐ 5-10 yrs exp 💼 Product

Lead enterprise-scale, cross-functional projects from initiation to delivery to meet company strategic objectives. Provide executive-level status updates and manage delivery risks for high-visibility programs supporting VP-level initiatives.

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Clinical Investigator I (Special Investigation Unit)

Centene Corporation · Full Time · a day ago

Centene Corporation

🌎 Bermuda, United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Healthcare

Audit medical records and claims data to identify inappropriate billing practices, fraud, and abuse. Recommend corrective actions and internal policy changes to prevent future erroneous billing practices.

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Supervisor, Recovery

Centene Corporation · Full Time · a day ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Others

Manage the workflow and activities related to the investigation, resolution, and recovery of complex claims and revenue cycle management. Supervise the recovery team, monitor performance standards, and handle escalated customer or payer issues.

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Utilization Review Clinician - Behavioral Health

Centene Corporation · Full Time · a day ago

Centene Corporation

🌎 United States 💵 $27.02 - $48.55 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Perform medical necessity reviews and authorization determinations for behavioral health services to ensure high-quality care. Monitor inpatient levels of care and collaborate with providers and medical directors to optimize treatment efficiency.

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Medical Director

Centene Corporation · Full Time · a day ago

Centene Corporation

🌎 United States 💵 $225K - $428K per year ⭐ 10+ yrs exp 💼 Healthcare

The Medical Director assists the Chief Medical Officer in directing medical management, quality improvement, and credentialing functions. They provide clinical leadership for utilization management and perform medical reviews of complex or experimental services to ensure quality decision-making.

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Clinical Extern

Centene Corporation · Full Time · 3 days ago

Centene Corporation

🌎 United States ⭐ 0-2 yrs exp 💼 Healthcare

Observe preceptors and participate in various projects to develop skills within the Managed Care industry. Gain hands-on experience by shadowing clinical services and following company guidelines.

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Senior IT Data Scientist

Centene Corporation · Full Time · 5 days ago

Centene Corporation

🌎 United States 💵 $102K - $190K per year ⭐ 5-10 yrs exp 💼 Software Development

Design and develop scalable AI/ML solutions and predictive models to improve health outcomes for members. Collaborate with internal customers to translate business objectives into technical use cases and deploy models using CI/CD pipelines.

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Associate Actuary - Medicaid

Centene Corporation · Full Time · 5 days ago

Centene Corporation

🌎 United States 💵 $87700 - $157K per year ⭐ 2-5 yrs exp 💼 Finance

Conduct pricing, risk assessment, and financial forecasting for assigned Medicaid health plans to estimate financial outcomes. Develop actuarial reports and tools to aid corporate strategy and improve insight into results.

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Associate Actuary, Strategic Analytics

Centene Corporation · Full Time · 5 days ago

Centene Corporation

🌎 Azerbaijan, Tunisia, United States 💵 $87700 - $157K per year ⭐ 2-5 yrs exp 💼 Software Development

The role involves designing and implementing actuarial methodologies to measure the financial impact of Value-Based Care and Quality and Affordability Initiatives. The Associate Actuary will serve as a strategic liaison, translating complex financial data into narratives for executive stakeholders.

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Utilization Review Clinician - Behavioral Health

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 United States 💵 $27.02 - $48.55 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Performs clinical reviews and assessments to determine the medical appropriateness of care for mental health and substance abuse services. Manages prior authorizations, concurrent reviews for inpatient care, and collaborates with providers and medical directors to improve care quality.

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Compliance External Audit Administrator

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 United States 💵 $70100 - $126K per year ⭐ 2-5 yrs exp 💼 Software Development

Manage complex compliance workflows, regulatory deliverables, and audit readiness activities to ensure alignment with healthcare regulatory requirements. Coordinate governance logistics for committees, maintain compliance documentation, and drive process improvements to strengthen internal controls.

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Director, Medicare Regulatory Change Management

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 Israel, United States 💵 $118K - $219K per year ⭐ 5-10 yrs exp 💼 Legal

Develop and implement strategies to maintain and implement regulatory requirements for assigned products across the company. Lead the tracking of laws and regulations while communicating impactful changes to key stakeholders and leaders.

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Manager, Sales Investigations

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 United States 💵 $87700 - $157K per year ⭐ 5-10 yrs exp 💼 Sales

Leads the day-to-day operations of a team of Sales Investigators to investigate misconduct by agents, brokers, and agencies. Ensures all investigative work is documented defensibly and aligns with internal policies, CMS requirements, and regulatory expectations.

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Senior Compliance Investigator

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 United States 💵 $70100 - $126K per year ⭐ 5-10 yrs exp 💼 Legal

Leads and conducts enterprise-wide compliance and ethics investigations across various business units and health plans. Responsible for analyzing facts, conducting witness interviews, and recommending remedial actions to mitigate future risks.

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Internal Auditor - AI Specialist

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Software Development

Perform risk-based internal audits by leveraging AI, automation, and data-enabled tools to enhance efficiency and insights. Design and implement AI-enabled solutions and dashboards to support audit execution and reporting.

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Quality Performance Clinical Pharmacist

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 United States 💵 $107K - $199K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Pharmacy Quality Performance Manager partners with health plans and provider groups to drive and accelerate pharmacy quality measures. This includes providing subject matter expertise across Medicare, Medicaid, and Marketplace lines of business to improve member and provider performance.

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Quality Performance Clinical Pharmacist

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 United States 💵 $107K - $199K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Pharmacy Quality Performance Manager partners with health plans and provider groups to drive and accelerate pharmacy quality measures. They serve as a subject matter expert across various lines of business to develop performance reviews and coordinate enterprise-wide quality initiatives.

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Compliance Corrections Specialist

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Legal

Oversees corporate ethics and compliance programs by conducting reviews and audits to ensure adherence to contractual and regulatory requirements. Collaborates with stakeholders to perform root cause analysis and implement corrective action plans for non-compliance issues.

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Senior Director, Pharmacy Operations

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 United States 💵 $185K - $352K per year ⭐ 10+ yrs exp 💼 Healthcare

Provide strategic leadership and operational oversight to pharmacists-in-charge across multiple locations. Establish the vision, policies, and budgets for the pharmacy program while ensuring regulatory compliance.

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Process Improvement Specialist

Centene Corporation · Full Time · 6 days ago

Centene Corporation

🌎 Bermuda, United States 💵 $70100 - $126K per year ⭐ 2-5 yrs exp 💼 Others

Identify and implement enterprise-wide process improvement activities using Lean and Six Sigma methodologies to support business infrastructure. Facilitate cross-functional teams to monitor performance metrics and communicate process gaps to upper management.

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Quality Program Development Manager

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 Azerbaijan, Tunisia, United States 💵 $70100 - $126K per year ⭐ 5-10 yrs exp 💼 Others

Lead the development and implementation of quality standards, policies, and workflows to improve clinical and administrative operations. Manage regulatory and accreditation deliverables for NCQA, PIP, and state compliance across Medicaid and Medicare lines of business.

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Clinical Formulary Pharmacist

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 Azerbaijan, United States 💵 $107K - $199K per year ⭐ 2-5 yrs exp 💼 Healthcare

Develop and maintain standard and custom drug formularies across various lines of business including Medicaid and Medicare. Analyze pharmacy cost trends and create clinical criteria for medication reviews and prior authorizations.

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Senior Compliance Corrections Specialist

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 United States 💵 $70100 - $126K per year ⭐ 5-10 yrs exp 💼 Legal

The role involves managing the corrections process by triaging non-compliance issues and coordinating remediation efforts using GRC tools. It requires collaborating with stakeholders to develop corrective action plans and providing trend analysis for senior leadership.

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Senior Director, Pharmacy

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 United States 💵 $185K - $352K per year ⭐ 5-10 yrs exp 💼 Healthcare

Manage all aspects of pharmacy operations and benefit management programs across multiple markets and products. Establish strategic visions, oversee vendor contracts, and manage pharmacy department staff to achieve organizational goals.

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Senior Director, Medicaid Compliance

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 Israel, United States 💵 $148K - $274K per year ⭐ 10+ yrs exp 💼 Legal

Lead the Compliance Advisory & Research and Compliance Response & Escalation teams to provide strategic direction across complex compliance functions. Partner with senior leadership to ensure business initiatives align with federal, state, and contractual requirements for the Medicaid line of business.

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SIU Investigator

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 0-2 yrs exp 💼 Others

Investigate allegations of healthcare fraud, waste, and abuse through claims audits and data analysis. Prepare detailed investigative reports for referral to state and federal agencies.

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Clinical Pharmacist (Care & Medication Therapy Management)

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 United States 💵 $107K - $199K per year ⭐ 2-5 yrs exp 💼 Healthcare

Manage high-risk patient populations to improve disease outcomes and ensure safe, cost-effective medication therapy. Collaborate with prescribers to optimize drug regimens and support quality department HEDIS metrics.

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Actuary

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 United States 💵 $107K - $199K per year ⭐ 5-10 yrs exp 💼 Finance

Conduct analysis, pricing, and risk assessments to estimate financial outcomes for high-priority Value-Based Care initiatives. Develop valuation models and analyze complex claims and clinical datasets to measure program efficacy and shared savings.

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Senior Compliance Administrator, Medicare Claims & Payment Integrity

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 Israel, United States 💵 $87700 - $157K per year ⭐ 5-10 yrs exp 💼 Software Development

Serves as a subject matter expert supporting the Medicare Compliance Advisory program to ensure alignment with CMS and federal regulations. Responsible for providing regulatory guidance, conducting risk analysis, and supporting audit readiness and corrective actions.

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SIU Investigator

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 0-2 yrs exp 💼 Others

Investigate allegations of healthcare fraud, waste, and abuse through claims audits and data analysis. Prepare detailed investigative reports for referral to state and federal agencies.

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SIU Investigator

Centene Corporation · Full Time · 7 days ago

Centene Corporation

🌎 Cayman Islands, India, United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Others

Investigate allegations of healthcare fraud, waste, and abuse through claims audits and data mining. Prepare detailed investigative reports for referral to state and federal agencies and coordinate resolutions with health plans.

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SIU Investigator

Centene Corporation · Full Time · 8 days ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 5-10 yrs exp 💼 Others

Investigate allegations of healthcare fraud, waste, and abuse through claims audits and data mining. Prepare detailed investigative reports for referral to state and federal agencies and coordinate resolutions with health plans.

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Senior Application Development Engineers

Centene Corporation · Full Time · 8 days ago

Centene Corporation

🌎 United States 💵 $148K - $169K per year ⭐ 2-5 yrs exp 💼 Others

Design, develop, and deploy software solutions and process flows while ensuring alignment with architectural standards and business requirements. Collaborate with architects and analysts to provide tier 3 application support and implement technical upgrades.

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Lead Data Engineers

Centene Corporation · Full Time · 8 days ago

Centene Corporation

🌎 United States 💵 $145K - $190K per year ⭐ 5-10 yrs exp 💼 Others

Design, build, and maintain scalable technology solutions and ETL processes to support business needs and reporting. Conduct root cause analysis and performance tuning for complex business processes while transitioning legacy reports to a Next Gen framework.

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SIU Investigator

Centene Corporation · Full Time · 8 days ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Others

Investigate allegations of healthcare fraud, waste, and abuse through claims audits and data analysis. Document findings and prepare detailed reports for referral to state and federal agencies.

APPLY

SIU Investigator

Centene Corporation · Full Time · 8 days ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 0-2 yrs exp 💼 Others

Investigate allegations of healthcare fraud, waste, and abuse through claims audits and data mining. Prepare detailed investigative reports for referral to state and federal agencies and coordinate resolutions with health plans.

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Manager, Payment Integrity - Platform Management

Centene Corporation · Full Time · 8 days ago

Centene Corporation

🌎 Bermuda, Canada, United States 💵 $87700 - $157K per year ⭐ 5-10 yrs exp 💼 Others

Develop and manage strategic fraud, waste, and abuse activities to ensure billing integrity and compliance with state and federal requirements. Lead teams of analysts in investigating referrals and preparing saving reports for stakeholders.

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Clinical Investigator - Behavioral Health

Centene Corporation · Full Time · 8 days ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Healthcare

Conduct comprehensive reviews of medical records and claims to identify potential fraud, waste, and abuse in behavioral health care. Collaborate with the Special Investigations Unit to analyze billing patterns and recommend preventative measures to internal policies.

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Clinical Investigator I (Special Investigation Unit)

Centene Corporation · Full Time · 8 days ago

Centene Corporation

🌎 Israel, Tunisia, United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Healthcare

Audit medical records and claims data to identify inappropriate billing practices, abuse, and fraud. Prepare findings summaries and recommend policy changes to prevent future fraudulent activities.

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Senior Medical Director - YouthCare

Centene Corporation · Full Time · 10 days ago

Centene Corporation

🌎 United States 💵 $225K - $428K per year ⭐ 10+ yrs exp 💼 Healthcare

Direct and coordinate medical affairs functions, overseeing utilization management, pharmacy, and the denials and appeals department. Provide medical leadership to improve the quality and cost-effectiveness of care for members while ensuring regulatory compliance.

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Supervisor, Utilization Management (RN)

Centene Corporation · Full Time · 11 days ago

Centene Corporation

🌎 United States 💵 $75300 - $135K per year ⭐ 5-10 yrs exp 💼 Healthcare

Supervises the clinical review team to ensure appropriate care through prior authorization, concurrent, and retrospective reviews. Monitors UM resources for compliance and quality while collaborating with senior management to improve processes and policies.

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Clinical Review Nurse - Prior Authorization

Centene Corporation · Full Time · 12 days ago

Centene Corporation

🌎 United States 💵 $27.02 - $48.55 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Analyzes prior authorization requests to determine medical necessity and appropriate levels of care based on national standards and member benefits. Coordinates with healthcare providers and medical directors to ensure timely review and cost-effective medical care.

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Senior Director, Product Development & Innovation

Centene Corporation · Full Time · 12 days ago

Centene Corporation

🌎 United States 💵 $148K - $274K per year ⭐ 10+ yrs exp 💼 Product

Oversee service product lines for Managed Long-Term Services and Supports (MLTSS) and Duals to ensure profitable growth and regulatory compliance. Lead the development of product extensions and establish strategic relationships with CMS and state Medicaid departments.

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Clinical Review Nurse-Concurrent Review

Centene Corporation · Full Time · 12 days ago

Centene Corporation

🌎 United States 💵 $27.02 - $48.55 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Performs concurrent reviews to evaluate medical necessity, overall health, and appropriate levels of care for members. Collaborates with medical directors and healthcare providers to ensure quality continuity of care and timely discharge planning.

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Director, AI Ethics and Governance

Centene Corporation · Full Time · 12 days ago

Centene Corporation

🌎 United States 💵 $148K - $274K per year ⭐ 10+ yrs exp 💼 Software Development

Executes the AI governance framework to ensure ethical implementation, fairness, and transparency of AI systems across the organization. Leads the management of AI programs, monitoring compliance, and mitigating risks associated with AI applications.

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Senior HEDIS Quality & Audit Analyst

Centene Corporation · Full Time · 13 days ago

Centene Corporation

🌎 United States 💵 $70100 - $126K per year ⭐ 5-10 yrs exp 💼 Others

The Senior Analyst serves as a subject matter expert leading complex HEDIS audit workstreams and ensuring audit-defensible documentation. They are responsible for interpreting regulatory requirements and partnering with stakeholders to mitigate submission risks.

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Vice President, Risk Adjustment Program Operations & Data Integrity

Centene Corporation · Full Time · 13 days ago

Centene Corporation

🌎 United States 💵 $188K - $359K per year ⭐ 10+ yrs exp 💼 Others

Provide operational leadership for Corporate Risk Adjustment programs, overseeing data integrity, validation audits, and encounter data submissions. Lead multi-disciplinary teams to drive enterprise change management and ensure compliance with regulatory standards.

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Senior Director, Clinical Data Science

Centene Corporation · Full Time · 13 days ago

Centene Corporation

🌎 Tunisia, United States 💵 $185K - $352K per year ⭐ 10+ yrs exp 💼 Software Development

Lead the enterprise strategy for clinical data science by developing AI-driven models to identify clinical risk and prioritize member interventions. Oversee the rigorous evaluation of clinical programs using causal inference and establish standards for model governance and responsible AI.

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Remote Medical Director

Centene Corporation · Full Time · 14 days ago

Centene Corporation

🌎 Bermuda, United States 💵 $236K - $449K per year ⭐ 10+ yrs exp 💼 Healthcare

Direct and coordinate medical management, quality improvement, and credentialing functions to optimize member care and cost-effectiveness. Perform medical reviews of complex cases and provide leadership for utilization management and regulatory compliance.

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Social Intelligence & Platform Operations Analyst

Centene Corporation · Full Time · 14 days ago

Centene Corporation

🌎 United States 💵 $70100 - $126K per year ⭐ 2-5 yrs exp 💼 Others

Lead day-to-day social listening and intelligence efforts to detect reputational risks and provide actionable insights for the business. Manage the operational backbone of social media platforms, including tool administration, vendor relationships, and governance.

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Sr Community Relations Coordinator

Centene Corporation · Full Time · 14 days ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 5-10 yrs exp 💼 Others

Serve as the primary liaison between the health plan and community stakeholders to promote services and guide strategic outreach initiatives. Coordinate community events, manage volunteer programs, and support members in accessing essential healthcare and transportation services.

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Sr. Manager, Privacy Compliance

Centene Corporation · Full Time · 15 days ago

Centene Corporation

🌎 United States 💵 $107K - $199K per year ⭐ 10+ yrs exp 💼 Legal

Manage and oversee the data privacy compliance program to ensure adherence to policies and regulations across the organization. Coordinate investigations into data privacy incidents and develop corrective actions to remediate non-compliance.

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Manager, SIU Prepay Investigations

Centene Corporation · Full Time · 19 days ago

Centene Corporation

🌎 India, Tunisia, United States 💵 $87700 - $157K per year ⭐ 5-10 yrs exp 💼 Others

Develop and manage strategic fraud, waste, and abuse activities to ensure billing integrity and compliance with state and federal requirements. Lead a team in investigating prepay referrals and preparing saving reports for stakeholders.

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Vice President, Network Strategy & Management Value-Based Contracting

Centene Corporation · Full Time · 20 days ago

Centene Corporation

🌎 United States 💵 $227K - $431K per year ⭐ 10+ yrs exp 💼 Others

Responsible for developing and managing the provider network strategy, including reimbursement, contracting, and unit cost management for Centene Corporation. Leads network development across expansion markets and oversees budgeting, forecasting, and contract negotiations to align with company goals.

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Remote National Medical Director

Centene Corporation · Full Time · 20 days ago

Centene Corporation

🌎 India, United States 💵 $236K - $449K per year ⭐ 10+ yrs exp 💼 Healthcare

Directs medical management, quality improvement, and credentialing functions to optimize care and cost-effectiveness for members. Performs complex medical reviews and provides leadership for utilization management and regulatory compliance.

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Senior Business Systems Analyst

Centene Corporation · Full Time · 21 days ago

Centene Corporation

🌎 United States 💵 $87000 - $161K per year ⭐ 5-10 yrs exp 💼 Others

Collaborates with business and IT stakeholders to translate complex requirements into functional and non-functional technical specifications. Manages the project lifecycle by creating process models, coordinating user acceptance testing, and maintaining system documentation.

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Vice President, Medicare Market Southeast

Centene Corporation · Full Time · 22 days ago

Centene Corporation

🌎 United States 💵 $227K - $431K per year ⭐ 10+ yrs exp 💼 Others

Responsible for the growth and P&L performance of Medicare markets in the Southeast region, focusing on membership, earnings, and quality. The role involves developing market-specific strategies and leading multi-disciplinary teams to drive operational excellence and value-based care initiatives.

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Senior Manager, Medical Loss Ratio

Centene Corporation · Full Time · 22 days ago

Centene Corporation

🌎 United States 💵 $107K - $199K per year ⭐ 5-10 yrs exp 💼 Healthcare

Accountable for the Medical Loss Ratio (MLR) compliance and reporting program, ensuring accurate calculations and timely federal and state filings. Leads cross-functional alignment and provides strategic oversight of MLR methodology, governance, and regulatory examinations.

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Manager, Payment Integrity- Readmission

Centene Corporation · Full Time · 22 days ago

Centene Corporation

🌎 United States 💵 $87700 - $157K per year ⭐ 5-10 yrs exp 💼 Others

Lead and oversee Payment Integrity initiatives focused on potentially preventable readmissions, cost recovery, and payment accuracy. Manage a team of auditors and clinical professionals to ensure compliant determinations and alignment with regulatory requirements.

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Director, Quality & Process Improvement, HEDIS Audit

Centene Corporation · Full Time · 22 days ago

Centene Corporation

🌎 United States 💵 $118K - $219K per year ⭐ 5-10 yrs exp 💼 Others

Lead and direct process improvement initiatives and HEDIS audit readiness to ensure accurate and timely regulatory submissions. Oversee quality assurance, training, and performance improvement projects while serving as the primary contact for auditors and leadership.

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Senior Director, Gold Card Program

Centene Corporation · Full Time · 22 days ago

Centene Corporation

🌎 Canada, United States 💵 $148K - $274K per year ⭐ 5-10 yrs exp 💼 Others

Oversee the Gold Card Program to ensure effective performance and communication of strategic priorities with stakeholders. Lead long-term program enhancements and integrate adaptive technology and expert services across business units to optimize behavior change outcomes.

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Data Analyst IV Healthcare Analytics, Medical Economics

Centene Corporation · Full Time · 25 days ago

Centene Corporation

🌎 United States 💵 $87700 - $157K per year ⭐ 5-10 yrs exp 💼 Software Development

Analyze extensive healthcare datasets to identify cost-saving opportunities and improve clinical outcomes for members. Collaborate with business stakeholders to develop reporting tools and communicate data-driven insights to optimize medical spend.

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Medical Director

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $225K - $428K per year ⭐ 10+ yrs exp 💼 Healthcare

Direct and coordinate medical management, quality improvement, and credentialing functions to improve care cost-effectiveness. Perform medical reviews of complex cases and provide leadership for utilization management and regulatory compliance.

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Chief Operating Officer, Illinois Health Practice Alliance

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $207K - $392K per year ⭐ 10+ yrs exp 💼 Healthcare

Accountable for day-to-day operations, profitability, and growth of the business unit. Responsible for developing strategic plans, managing provider networks, and ensuring compliance with state and federal regulatory agencies.

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Lead Information Risk Analyst

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 Bermuda, Canada, United States 💵 $107K - $199K per year ⭐ 5-10 yrs exp 💼 Finance

Lead enterprise-wide security governance, compliance execution, and audit readiness while managing GRC platforms. The role involves interpreting regulatory requirements and providing expert guidance to senior stakeholders on risk and compliance trade-offs.

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Program Manager – PA Governance

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $87700 - $157K per year ⭐ 5-10 yrs exp 💼 Product

Lead enterprise-wide Prior Authorization governance to ensure disciplined planning, data-driven prioritization, and effective execution of regulatory and clinical initiatives. Partner with cross-functional leaders to manage change, track project lifecycles, and translate decisions into measurable operational outcomes.

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UX Architect

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $87000 - $161K per year ⭐ 2-5 yrs exp 💼 Software Development

The UX Architect is responsible for designing the structure, flow, and layouts of digital solutions to ensure intuitive user interactions. They facilitate design thinking workshops and collaborate with cross-functional teams to implement user interface enhancements.

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Senior Manager, Sales Investigations

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 Bermuda, India, United States 💵 $107K - $199K per year ⭐ 5-10 yrs exp 💼 Sales

Leads the Sales Investigations Team in overseeing misconduct allegations, fraud, waste, and abuse within Medicare Advantage sales. Establishes investigative standards and coordinates with regulatory bodies like CMS and law enforcement to mitigate compliance risks.

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Senior Adversarial Emulation - Red Team Operator

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 Azerbaijan, United States 💵 $87000 - $161K per year ⭐ 5-10 yrs exp 💼 Software Development

Lead the planning and execution of red team operations to identify vulnerabilities and control gaps across on-premises and cloud environments. Design advanced obfuscation techniques and malware solutions to evade detection and enhance the enterprise security posture.

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Medical Director

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $215K - $408K per year ⭐ 10+ yrs exp 💼 Healthcare

Direct and coordinate medical management, quality improvement, and credentialing functions for the business unit. Provide medical leadership for utilization management and cost containment while reviewing complex medical services for necessity.

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Director, Privacy & Security Enterprise Engagement

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $148K - $274K per year ⭐ 10+ yrs exp 💼 Others

Lead the Privacy & Security Enterprise Engagement Officers team to ensure regulatory and contractual compliance across health plan lines of business. Build partnerships with stakeholders to manage risks, oversee AI governance, and drive continuous improvement in security engagement.

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Care Manager

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Healthcare

Develop and facilitate complex care management activities for members with mental and behavioral health needs, specifically focusing on the adolescent foster care population. Coordinate between members, families, and providers to ensure access to necessary healthcare services and social determinants of health resources.

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Account Executive II (Specialty Pharmacy)

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Sales

Represent the company to prospective and existing clients while monitoring client satisfaction. Collaborate with various departments to resolve client issues and enhance satisfaction.

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Director, Third Party Risk Managment

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $118K - $219K per year ⭐ 10+ yrs exp 💼 Others

Drive the strategy and execution of the organization's third-party risk management program, overseeing due diligence and compliance monitoring. Lead issue management and executive-level reporting to ensure adherence to regulatory and accreditation requirements.

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Vice President, Network Development & Contracting

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $180K - $343K per year ⭐ 10+ yrs exp 💼 Others

Direct provider network strategy and contracting activities, including access analysis and reimbursement management. Lead the development of provider networks across expansion markets and oversee budgeting and forecasting for network costs.

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Remote Medical Director, Appeals

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $236K - $449K per year ⭐ 10+ yrs exp 💼 Healthcare

Directs medical management, quality improvement, and credentialing functions to optimize care and cost-effectiveness for members. Performs complex medical reviews and provides leadership for utilization management and medical necessity appeals.

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DRG Reviewer

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $70100 - $126K per year ⭐ 5-10 yrs exp 💼 Others

The DRG Reviewer is responsible for conducting comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure accuracy in DRG assignment and reimbursement. This role involves collaborating with the Medical Director on complex cases and leading evaluations to identify opportunities for developing medical policy.

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Care Manager (Behavioral Health)

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 2-5 yrs exp 💼 Healthcare

Develops and facilitates complex care management activities for members with mental and behavioral health needs. Coordinates care plans and collaborates with providers to ensure members have access to necessary services.

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SIU Investigator

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 0-2 yrs exp 💼 Others

Investigate allegations of healthcare fraud, waste, and abuse through claims audits and data analysis. Prepare detailed investigative reports for referral to state and federal agencies and coordinate resolutions with health plans.

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SIU Investigator

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $56200 - $101K per year ⭐ 5-10 yrs exp 💼 Others

Investigate allegations of healthcare fraud, waste, and abuse through claims audits and data analysis. Prepare detailed investigative reports for referral to state and federal agencies.

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Corporate Ethics & Compliance Investigator

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 India, United States 💵 $107K - $199K per year ⭐ 10+ yrs exp 💼 Legal

Lead and manage complex, high-impact internal investigations to ensure adherence to federal and state regulations and internal ethical standards. Act as a strategic advisor to senior leadership by analyzing records, conducting interviews, and recommending remedial actions to mitigate risk.

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Senior Manager, Enterprise Compliance Corrections

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $87700 - $157K per year ⭐ 5-10 yrs exp 💼 Legal

Lead a team responsible for remediating and reporting non-compliance with Medicaid, Medicare, and Commercial regulatory requirements. Partner with internal leadership and product compliance teams to ensure timely resolution of identified issues and continuous program improvement.

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Compliance Officer

Centene Corporation · Full Time · a month ago

Centene Corporation

🌎 United States 💵 $148K - $274K per year ⭐ 10+ yrs exp 💼 Legal

Provide strategic leadership and oversight for the health plan compliance program, ensuring adherence to CMS Medicare and state Medicaid requirements. Lead regulatory strategy, manage state interactions, and collaborate with risk management to reduce business risks.

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Utilization Review Clinician - ABA

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $26.5 - $47.59 per hour ⭐ 2-5 yrs exp 💼 Others

The Utilization Review Clinician performs reviews of members' care and health status related to Applied Behavioral Analysis (ABA) services to determine medical appropriateness. They monitor clinical effectiveness and efficiency of care in accordance with ABA guidelines and provide education to members and their families regarding the utilization process.

counselor medical feedback leadership behavioral-health therapist organization

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Director, People Analytics

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States ⭐ 10+ yrs exp 💼 Software Development

Directs the organization with critical information for fact-based decisions and manages business and reporting analysts to produce operational reports. Leads the execution of projects based on predictive analytics and collaborates with various teams to provide effective reporting solutions.

sas medical reporting leadership testing organization

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Quality Program Strategist II

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $68700 - $123K per year ⭐ 5-10 yrs exp 💼 Others

Identify market trends and oversee functions of quality improvement programs. Collaborate with stakeholders to analyze business issues and recommend solutions for performance improvements.

insurance data-analysis training compliance

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Care Manager (RN)

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $55100 - $99000 per year ⭐ 2-5 yrs exp 💼 Healthcare

Develop and facilitate complex care management activities for members, focusing on physical and mental health needs. Collaborate with providers and community resources to create personalized care plans and ensure members receive appropriate care.

feedback leadership compliance

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Utilization Review Clinician - Behavioral Health

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $26.5 - $47.59 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The Utilization Review Clinician performs clinical reviews and assesses care related to mental health and substance abuse. They monitor and determine the appropriateness of care levels and services, ensuring they meet medical guidelines.

call-center counselor medical staffing leadership behavioral-health therapist organization

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Care Coordinator II

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $17.5 - $27.5 per hour ⭐ 0-2 yrs exp 💼 Healthcare

The Care Coordinator II supports care management activities and ensures services are delivered by healthcare providers. They interact with members through outreach and coordinate care activities based on care plans.

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Care Coordinator II

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $17.5 - $27.5 per hour ⭐ 0-2 yrs exp 💼 Healthcare

Supports care management activities and ensures services are delivered by healthcare providers. Engages members through outreach to discuss care plans and coordinates care activities as needed.

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Trainer I

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $55100 - $99000 per year ⭐ 2-5 yrs exp 💼 Teaching

The Trainer I is responsible for developing and conducting training programs for Member and Provider Service roles in Centene’s contact centers. This includes conducting training needs analyses, evaluating training effectiveness, and assisting in auditing staff work.

training

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RN Clinical Review Nurse - Concurrent Review

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $26.5 - $47.59 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The RN Clinical Review Nurse performs concurrent reviews to evaluate the necessity and appropriateness of care being delivered to members. This includes collaborating with healthcare providers and contributing to discharge planning according to established guidelines.

medical feedback leadership organization

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Care Management Support Coordinator II

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $17.5 - $27.5 per hour ⭐ 0-2 yrs exp 💼 Support

Supports administrative care management activities including outreach, answering calls, and scheduling services. Acts as a point of contact for members and providers to resolve issues and document member records.

onboarding

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Provider Data Coordinator I - Managed Care

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $19.04 - $32.35 per hour ⭐ 0-2 yrs exp 💼 Others

Perform day-to-day functions to maintain provider databases and create reports to monitor network compliance with state requirements. Provide general administrative support of the assigned department.

communication reporting microsoft-office data-management compliance

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Senior Curriculum Designer

Centene Corporation · Full Time · 8 months ago

Centene Corporation

🌎 United States 💵 $68700 - $123K per year ⭐ 5-10 yrs exp 💼 Design

Design and implement instructional strategies that support learning and performance for providers, caregivers, and external stakeholders. Oversee maintenance of training resources and support sites while developing instruments to assess individual change in knowledge and skills.

sharepoint project-management training behavioral-health instructional-design

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