Jobs at Centene Corporation

Serve as lead legal counsel for Centene's Medicare brand advising on Medicare Advantage, Part D, and Duals regulatory matters. Research and interpret complex healthcare regulations, draft and negotiate contracts and policies, manage provider disputes and outside counsel, support risk adjustment, MLR, Stars, bids, and cross-functional business implementation.

Provide high-level administrative support to an executive, handling confidential materials, coordinating meetings and events, preparing correspondence and reports, communicating policies, and managing records and logistics to maximize executive efficiency.

Manage provider data management operations, supervise staff, oversee provider directory and contract setup activities, coordinate cross-functional projects with IS, design reports and workflows, ensure data integrity, train stakeholders, and support claims adjudication and process improvements.

Lead and coordinate departmental operations, manage workflow and staff, maintain production and quality standards, ensure regulatory compliance, analyze reports for decision-making, set strategic objectives, improve procedures, and coordinate cross‑functional activities.

Manage Medicare or Broker Field Sales teams to drive regional enrollment growth. Recruit, onboard, train, engage, and ensure compliance of independent agents. Develop market- and provider-specific sales plans, maintain broker and community relationships, manage incentives and distribution, and collaborate with internal teams to meet sales goals.

12-week clinical externship observing preceptors and participating in managed care projects. Learn clinical processes and services, follow preceptor guidance, gain hands-on experience, and develop managed care-related clinical skills while receiving course credit.

Lead and own the 5-year financial planning model (IS, BS, CF); produce financial analysis and reports for management; create templates and optimize systems; drive reporting and transition long-range plans into the annual budget; serve as financial representative on special projects and support executive leadership.

Lead HEDIS audit readiness and submission activities, interpret NCQA/CMS requirements, manage complex audit workstreams, assess and mitigate audit risks, support CMS submissions, develop enterprise standards and documentation, and advise stakeholders on regulatory and submission decisions.

Lead proposal development and capture efforts for business growth: set strategy, analyze RFPs, create proposal plans and compliance matrices, manage cross-functional teams, write/edit key proposal sections, run reviews, and oversee pipeline and opportunity reporting to support pursuit decisions.

Lead provider contracting, network development, and provider relations functions. Recruit and contract provider networks for new and expansion markets, oversee staff and consultants, perform financial analyses to identify cost improvements, implement contracting strategies, monitor performance, and develop solutions to address process and quality gaps. Support new business launches and travel for internal and provider-facing meetings.

Lead large-scale, cross-functional enterprise transformation initiatives. Manage full project lifecycle—requirements, plans, schedules, budgets, resources, governance, risk mitigation, and deliverables. Coordinate stakeholders, communicate status, facilitate meetings, and ensure quality of design, test, training, and operations artifacts using standard PM tools and methodologies.

12-week unpaid externship observing preceptors and participating in projects to develop clinical knowledge and skills within the managed care industry. Shadow clinical staff, learn processes and functions, and follow preceptor or manager instructions. Must receive course credit.

Process and adjudicate first-time medical claims, apply policies and provider contracts to determine reimbursement eligibility, research claim statuses, maintain documentation, meet production and quality standards, and complete required claims training. May use Amisys/Xcelys and medical coding knowledge.

Provide clinical data analysis, audits, and workflow recommendations to ensure compliance (HEDIS, URAC, NCQA). Design data pulls, produce analytical and audit reports, support corrective action plans, training, and regulatory audit preparation. Collaborate with clinical teams and data analysts to track performance, forecast staffing, and improve operational processes.

Performs concurrent reviews to evaluate members' overall health, medical necessity, level of care, and discharge planning. Documents findings in health management systems, collaborates with providers, medical directors, and care management, provides provider education on utilization processes, and recommends or approves medical determinations per policies.

Review psychological testing and treatment documentation for medical necessity and quality; authorize and monitor outpatient behavioral health and substance abuse care; conduct peer reviews; consult with providers and Medical Director; educate network practitioners on best practices and utilization management; respond to complaints and provide clinical oversight for outpatient services.

Support prior authorization processes by documenting requests, verifying member coverage, entering data into utilization management systems, routing requests to clinical reviewers, and maintaining authorization and referral tracking per policy.

Analyze contact center workload, forecast volumes, and build staffing and scheduling plans. Monitor performance metrics (service level, ASA, adherence), identify disruptions, prepare reports, and recommend improvements. Maintain schedules, time-off records, and provide feedback to supervisory staff. Support workforce management policies and ad-hoc analyses.

The Senior Business Systems Analyst collaborates with stakeholders to translate complex requirements into technical specifications, ensuring alignment with strategic goals. Responsibilities include gathering business requirements, creating process models, managing project lifecycles, and providing user support.

Lead business case development and strategic planning; manage large cross-functional process improvement initiatives; analyze data, workflows, policies and staffing; organize and facilitate work teams; ensure initiative execution, transition, and communications using project management tools.