Teams 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.