Jobs at Centene Corporation

Leads large-scale healthcare technology migrations and enterprise programs, overseeing scope, schedules, budgets, risks, dependencies, cross-functional teams, executive communications, dashboards, training, and issue escalation. Coordinates project managers and business analysts while supporting clinical platform integration, interoperability, cutover, go-live, stabilization, and organizational transformation initiatives.

Supervise recovery and revenue cycle management workflows, ensuring performance standards, process compliance, and timely resolution of complex claims issues. Monitor aging reports, accounts receivable credits, cash-to-revenue activity, unapplied payments, and customer and payer calls. Investigate escalated issues, support team responses, serve as an internal subject matter resource, and manage employee hiring, coaching, motivation, and counseling.

Manage strategic partnerships with contracted provider networks to improve value-based care performance, quality, cost, utilization, and financial outcomes. Serve as the primary provider contact, resolve claims and operational issues, educate providers on policies and tools, analyze HBR and HEDIS performance, develop improvement strategies, prepare reports for leadership meetings, and coach less experienced representatives. The remote role requires local travel and occasional travel up to 10%.

Leads business case development, strategic planning, and large cross-functional initiatives. Manages project teams, process analysis, workflow mapping, consensus building, implementation oversight, and performance improvement efforts. Uses project management tools and detailed analysis to improve financial results, customer satisfaction, compliance, and operational effectiveness. Requires a bachelor’s degree, six or more years managing projects, and PMP certification.

Leads national Medicare Advantage and duals strategy, public policy, regulatory initiatives, and cross-market program execution. Builds relationships with internal leaders, government stakeholders, and advisory groups to influence policy and business decisions. Develops strategy playbooks, advises on regulatory matters, coordinates filings and submissions with Compliance and Regulatory Affairs, leads change management, and manages direct reports across Medi-Cal and other functional teams.

Leads enterprise talent initiatives including leadership development, succession planning, and talent readiness programs. Manages projects through the full lifecycle, including requirements, planning, budgeting, resourcing, execution, risk mitigation, documentation, and stakeholder communication. Partners with HR leaders and business stakeholders to align resources, resolve issues, and support workforce transformation. The role requires onsite attendance and candidates local to or within driving distance of St. Louis.

Oversee operations and business strategy by coordinating cross-functional teams, analyzing data, improving performance metrics, supporting strategic initiatives, and implementing quality improvement processes. The role involves identifying operational issues, reducing waste and rework, improving customer and staff satisfaction, and advising on organizational improvement activities. Requires travel up to 25% and remote work within the continental United States.

Conduct behavioral health and Applied Behavior Analysis utilization reviews, authorize and monitor medically necessary care, and evaluate psychological testing and outpatient service requests. Collaborate with psychologists, therapists, BCBAs, providers, and medical directors; provide education on best practices and utilization management; address complaints; and participate in outpatient clinical rounds. The role requires an active California psychologist license and expertise in behavioral health, psychological testing, diagnostic evaluations, and evidence-based Autism Spectrum Disorder practices.

Leads complex provider and vendor contract negotiations, implementations, relationship management, financial analysis, operational reporting, and partnership performance tracking. Develops corrective action plans, modifies agreements, conducts market research, and presents negotiation strategies, performance data, scorecards, and partnership recommendations to health plans, corporate teams, and executives. The role supports affordability, network adequacy, and sustainable provider network outcomes.

Retains health program membership by assisting members with applications and recertification, answering eligibility and service questions, conducting follow-up calls, requesting missing documentation, resolving concerns, and documenting account activities. Maintains member databases and completes required administrative paperwork while meeting daily production metrics. Requires customer service experience, computer proficiency, and preferably fluency in Chinese, Spanish, or Russian.

Manage medical collections by verifying insurance eligibility, reviewing aging reports, collecting reimbursements, negotiating discounts, appealing claims, documenting communications, processing account adjustments, and resolving billing errors. The role requires customer service, medical billing, insurance claims knowledge, and collection experience while informing patients of financial responsibilities.

Leads enterprise HEDIS quality oversight, NCQA audit readiness, regulatory interpretation, risk mitigation, documentation, and CMS submission support. Serves as a subject matter expert, manages complex audit workstreams, validates reporting and submissions, develops enterprise controls, supports corrective actions, and prepares leadership reporting. Partners with health plans, auditors, IT, analytics, and quality stakeholders to improve audit defensibility and submission accuracy.

Lead and oversee all training programs: perform needs assessments and gap analyses, develop curriculum and materials with SMEs, deliver and facilitate online and in-person training, evaluate effectiveness and ROI, manage vendors and training calendar, support onboarding and employee development, audit results and implement improvements, and identify cost savings. Travel as required.

Drive specialty pharmacy growth by developing provider and client relationships, managing referral pipelines, negotiating renewals, and improving patient access to therapies. Coordinate with clinical teams, payers, manufacturers, hubs, and case managers to resolve access barriers. Deliver education and training, monitor client satisfaction, analyze territory and referral data, identify growth opportunities, and optimize account performance through CRM planning. Travel approximately 30%, including overnight trips.

Supervises utilization management clinical review teams responsible for prior authorization, concurrent review, and retrospective review. Ensures compliance, quality, performance, and efficiency standards; supports complex member-care issues; and helps develop UM policies and process improvements. Provides coaching, education, feedback, onboarding, hiring, and training while coordinating with senior management and ensuring adherence to regulatory and accreditation requirements.

Audits medical claims and provider data for accurate adjudication, policy compliance, and regulatory adherence. Researches discrepancies, identifies root causes, reports findings and recommendations, maintains quality statistics, communicates results to claims teams, and contributes data to training, policies, and process improvements.

Leads the sales operations department, including reporting, data management, sales systems, broker support, commissions, incentives, forecasting, budgeting, and cross-functional project delivery. Oversees staff, processes, performance monitoring, system enhancements, and alignment with sales and finance leadership. Serves as the senior liaison to sales executives, cross-functional partners, brokers, and agents while managing department-wide initiatives and operational improvements.

Supports health services data management and quality improvement initiatives. Responsibilities include developing reports, coordinating performance audits, validating data accuracy and integrity, reporting quality outcomes to management, managing databases and related procedures, and supporting committees. Requires an associate degree or equivalent experience and at least two years of data management, reporting, project management, or quality improvement experience. Applicants must reside in Iowa or Kansas.

Provides senior-level technical and business analysis focused on SAS, SQL, Snowflake, Databricks, and ETL pipelines. Designs and implements business applications, databases, reports, and automated processes; analyzes requirements, data, operational procedures, and financial impacts. Serves as a SAS subject matter expert, resolves complex system issues, supports testing and debugging, monitors project progress, recommends solutions, and trains staff.

Directs sales and marketing strategy for Medicaid, Medicare, and Health Insurance Marketplace products. Develops local sales plans, membership and growth goals, prospect relationships, brand identity, media and vendor partnerships, communications, community outreach, and competitive monitoring. Collaborates across departments to execute marketing initiatives and drive membership growth across geographic markets and product lines.