Jobs at Centene Corporation

Supervises utilization management nurses conducting prior authorization, concurrent, and retrospective reviews. Oversees performance, compliance, quality, staffing, coaching, onboarding, and training while resolving complex member care issues. Develops and implements utilization management policies, supports regulatory compliance, promotes process improvements, and coordinates communication among team members, members, providers, and senior management.

Lead enterprise-wide programs transforming contact center and telephony platforms from Avaya to AWS Connect. Manage scope, schedules, budgets, resources, risks, dependencies, and cross-functional teams. Coordinate project managers and business analysts, provide executive dashboards and steering committee updates, resolve escalated issues, and support training and process improvement. The role requires strong program leadership, executive communication, and experience delivering complex IT initiatives in high-visibility environments.

Analyzes and resolves provider claims, authorization appeals, and member grievances. Prepares response letters, maintains appeal and grievance files, and may coordinate committee activities. Supports pay-for-performance and HEDIS programs through data entry, provider outreach, claims research, and information tracking. Manages high volumes of documents and incoming mail while complying with organizational policies and standards.

Performs concurrent utilization reviews to assess member health, medical necessity, appropriate care settings, resource use, length of stay, and discharge planning. Documents findings, collaborates with providers, Medical Affairs, Medical Directors, and care management, and supports authorization decisions and utilization education. Requires an active California RN license, nursing education, and acute care experience. Remote schedule includes weekday, weekend, and holiday rotations.

Reviews Applied Behavioral Analysis services for medical appropriateness, conducts behavioral health prior authorizations, analyzes member data, collaborates with providers, educates members and families, and recommends care process improvements. Requires an independent clinical license or BCBA certification, behavioral health and ABA expertise, and experience assessing ABA treatment plans and utilization.

Coordinates safe transitions for members across healthcare settings and community services. Develops and supports transition, service, and care plans; coordinates with providers, care teams, members, and caregivers; explains service requirements and limitations; assists with assessments and screenings; tracks transition metrics; documents care information; and supports education and process improvement initiatives.

Leads strategy and execution for ICHRA provider networks across multiple markets. Responsibilities include provider network development, value-based contracting, contract negotiations, provider performance improvement, budgeting and forecasting, stakeholder relationships, advisory boards, governance, and network expansion. The role manages network development staff and requires extensive healthcare administration, managed care, provider contracting, and leadership experience.

Leads business case development, strategic planning, and large cross-functional initiatives. Drives process improvement through workflow analysis, project planning, facilitation, consensus building, policy guidance, and implementation oversight. Ensures initiatives align with business objectives, improve performance, generate financial gains, enhance customer satisfaction, and support compliance. Communicates recommendations and progress across organizational levels while supporting other project leaders.

Coordinates access to care for health plan members, resolving complex service issues and referrals involving public agency programs. Collaborates with internal departments, providers, and external agencies; supports programs including California Children’s Services, Regional Centers, and H.E.L.P. The role also prepares appeals and grievance documentation, submits compliance reports, and monitors cases through resolution.

Provides strategic, operational, and administrative support to California market healthcare executives. Coordinates cross-functional initiatives, action plans, executive communications, staff meetings, risk updates, strategic planning activities, and special projects. Represents executive leadership in meetings, tracks deliverables and interdependencies, prepares presentations, and ensures follow-through across business and functional teams.

Designs, develops, integrates, and supports enterprise IAM solutions, including identity governance, provisioning, SSO, MFA, PAM, RBAC, and access certification. Troubleshoots and modifies code, builds APIs and automation, leads integrations, creates technical standards and documentation, and serves as a senior escalation point. Partners across security, infrastructure, applications, and business teams while contributing to IAM architecture, cloud identity, Zero Trust, DevSecOps, compliance, and platform roadmaps.

Leads national, multichannel marketing strategy and execution to drive acquisition and retention for ICHRA insurance plans. Oversees annual plans, media investment, creative and content, agency partnerships, SEO, analytics, ROI optimization, and consumer insights. Builds a digital-first, high-performance marketing culture; develops talent; influences product strategy; and collaborates with Sales, Product, Operations, Finance, HR, and Compliance to achieve growth and financial commitments.

Lead pharmacy operations across multiple markets and products, develop and implement pharmacy benefit management programs, manage vendor contracts and accreditation participation, analyze utilization and financial data, oversee pharmacy staff, and support provider education and budget planning to achieve organizational pharmacy and medical goals.

Lead and oversee the Gold Card Program, driving long-term program development, integration across business units, and ensuring consumer experience, clinical, and engineering expertise inform product design. Manage adaptive technology integration, team-based services for behavior change outcomes, and evaluate financial performance and value propositions for program enhancements and new development.