Jobs at Centene Corporation

The Vice President will direct provider network activities, lead provider network strategy, manage budget forecasts, and oversee contracting negotiations and analyses for Centene.

Supervise utilization management nursing team handling prior authorization, concurrent and retrospective reviews. Ensure compliance with regulations and quality standards, coach and evaluate staff, lead process improvements, assist hiring and training, and collaborate with senior management on UM policies and complex member care issues.

Independently review and validate MS-DRG and APR-DRG coding and inpatient clinical documentation to ensure accurate DRG assignment and reimbursement. Apply advanced ICD-10-CM/PCS knowledge, reference authoritative sources, prepare audit findings, support appeals, ensure regulatory and payer compliance, collaborate with Medical Director on complex cases, and contribute to audit methodology and policy development while meeting quality and productivity standards.

Oversee accurate financial recordkeeping and reporting for payment integrity. Produce, analyze, and review monthly, statistical, and ad-hoc reports on cost, quality, and effectiveness. Perform complex financial analyses, prepare recommendations for management, and develop business knowledge of healthcare payment, risk, contracting, and benefits. Ensure timely reports, support decision-making, and comply with company policies.

Supervise a utilization management clinical team handling prior authorization, concurrent and retrospective reviews for NICU members. Monitor performance, ensure regulatory and policy compliance, coach and train staff, lead quality/process improvements, collaborate with senior management, and support hiring/onboarding.

Perform accounts payable/receivable and claims payments, maintain daily cash balances and monthly bank reconciliations, reconcile general ledger accounts, analyze financial data, support financial/regulatory/health plan audits, and manage check generation and related AP processes while complying with policies.

Lead the design, build, test, and maintenance of enterprise Identity and Access Management systems. Enforce identity lifecycle policies, develop IAM strategies and standards, implement identity governance, troubleshoot security-focused IAM issues, liaise with security, architecture, and business teams, lead cross-functional implementations, and ensure regulatory and corporate compliance.

Lead development and execution of operational excellence strategies for Population Health & Clinical Outcomes. Oversee PMO, clinical appeals, compliance oversight, process standardization, KPI reporting, and continuous improvement using Lean/Six Sigma. Build and mentor teams, collaborate cross-functionally, and present operational performance to senior management.

Lead provider contracting, network development, and provider relations functions. Recruit and contract provider networks for new and expansion markets, support new business launches, perform financial analyses to drive cost improvements, oversee staff and consultants, ensure regulatory compliance, close provider agreements, and implement business solutions to address process and quality gaps.

Independently review and validate MS-DRG and APR-DRG coding and clinical documentation, verify ICD-10-CM/PCS assignments, identify discrepancies, support appeals, and ensure regulatory and payer compliance while meeting quality and productivity standards.

Independently review and validate MS-DRG and APR-DRG coding and clinical documentation to ensure accurate DRG assignment and reimbursement. Verify ICD-10-CM/PCS codes, identify discrepancies, support DRG appeals, prepare audit findings referencing authoritative sources, and help develop audit methodologies and medical policy. Collaborate with Medical Director on complex cases and meet quality and productivity standards.

Create, edit, and distribute clear, compliant communications for the national Gold Card program. Coordinate reviews with SMEs, training, compliance, and marketing; manage content changes, translations, and employee communications; ensure regulatory alignment and timely information delivery to providers and internal stakeholders.

The Program Manager oversees Prior Authorization governance, ensuring compliance and efficiency through project management, strategic planning, and stakeholder engagement.

Lead enterprise-scale, cross-functional projects from initiation through delivery. Translate executive priorities into scopes, timelines, and governance. Coordinate across Quality, Analytics, Technology, Operations, vendors, and markets; manage risks, issues, dependencies, and change. Provide executive-ready status updates, facilitate governance and leadership reviews, and ensure adherence to enterprise PM standards to drive outcomes and delivery accountability.

Lead business case development and strategic planning for cross-functional initiatives; drive process improvement, financial performance, compliance, and implementation. Organize teams, perform data and workflow analysis, facilitate meetings, manage projects, and communicate changes across all organizational levels.

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 all finance functions for a business unit, including budgeting, forecasting, financial analysis, medical cost trend identification, rate setting, audit leadership, pricing validation, and acting as the primary liaison between Corporate Finance and the business unit to support strategic and operational objectives.

Lead enterprise quality improvement for a national health plan: manage NCQA/HEDIS accreditation and performance, oversee risk-adjustment quality, collaborate on Medicare STARS (HEDIS/CAHPS/HOS), drive provider satisfaction and cultural competency/health equity initiatives, implement best practices and technologies, present results to senior leadership, and manage related policies, procedures and budgets.

Lead product strategy, roadmaps, and governance for enterprise clinical migrations and integrations. Drive large-scale data migrations, cutovers, go-live and stabilization; influence executives; coordinate vendors; ensure agile delivery, ROI, budgeting, and cross-functional change management for multiple global products.

Lead strategic product direction and lifecycle for enterprise clinical technology products. Build roadmaps, align stakeholders, manage funding and ROI, govern product delivery from concept to production, coach agile teams, and drive cross-functional collaboration to implement scalable, global solutions.