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This role is responsible for leading the end-to-end implementation of technology solutions supporting Care Management, translating business and clinical requirements into scalable, well-governed system deployments. The Implementation Manager drives delivery from design through go
Position Purpose: Responsible for leading the integration, modernization, and efficient operation of Centene's enterprise telephony and contact center platforms. Involves close collaboration with business process owners, external technology vendors, and Business Technology System
Position Purpose: Provides strategic and operational leadership for enterprise interoperability capabilities across the enterprise. Responsible for enabling healthcare data to move securely and seamlessly between systems, organizations, stakeholders including members, providers,
Position Purpose: Supervises care coordination activities to assigned members to ensure appropriate services are delivered by the team and providers while ensuring continuity of care across care/services. Supervises day-to-day activities of care coordination team members and issu
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Key Details:
Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephoni
Position Purpose: Observe preceptors and participate in various projects to learn and develop skills related to the Managed Care industry. - Develop clinical knowledge and skills by learning about various processes and functions within the Managed Care industry - Observe process
Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Key Details: This is a remote position, and
Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes. Key Details: Candidate must reside within the state of Louisiana. Must be authorized to work in the U.S. w
Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Key Details: This
Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Key Details: Applicants must reside in Centr
Position Purpose: Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, medical records, provider information, and other relevant evidence to identify potential misconduct and support case resolution. Document investigative activities, prepare
Position Purpose: Lead and coordinate large-scale, cross-functional enterprise transformation initiatives that require complex stakeholder alignment, execution management, and disciplined governance. These initiatives span multiple business functions, lines of business, and opera
This is a remote position and can be located anywhere in the US. Position Purpose: Develop innovative procurement solutions at a project/category/organizational level and provide guidance to category team for sourcing event level strategies. Engage senior leadership team to driv
Develops, assesses and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes. Evaluates member service needs and develops or contri
Position Purpose: Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencie
Position Purpose: The Clinician Specialist provides clinical and operational support, guidance, and direction to the department related to utilization management and/or case management. The position is responsible to develop, implement, and monitor clinical documentation incorpor
Position Purpose: Leads the strategy, development, and execution of product, customer experience, digital and operational capabilities for the ICHRA business. Responsible for translating customer and market insights into scalable solutions, driving digital innovation, operational
Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephoni
This role is responsible for leading the end-to-end implementation of technology solutions supporting Utilization Management, translating business and clinical requirements into scalable, well-governed system deployments. The Implementation Manager drives delivery from design thr