Teams 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.