Jobs at Centene Corporation

Act as a liaison to improve pharmacy quality performance, collaborating with providers and pharmacies, and ensuring timely insights while managing territory engagement plans.

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.

Remote psychologist reviewer specializing in ABA for youth with Autism. Authorize, direct, and monitor behavioral health services; conduct peer reviews; educate network providers; consult with Medical Director; respond to complaints; provide clinical oversight of outpatient services.

Lead and conduct enterprise-wide compliance and ethics investigations across business units and health plans. Assess allegations, review documents, interview witnesses, prepare investigation reports, recommend remediation or discipline, track corrective actions, maintain case files in centralized systems, produce metrics and presentations, and collaborate with cross-functional stakeholders to ensure regulatory defensibility.

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.

Remote psychologist reviewer authorizes and monitors behavioral health/ABA care, conducts peer reviews, provides clinician education on best practices and utilization management, responds to complaints, collaborates with Medical Director, and offers clinical oversight for outpatient services.

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.