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Position Purpose: Develop written responses to complex, high-scoring Medicaid Request for Proposal (RFP) section supporting the company's growth and expansion goals. Key Details: Occasional evening and weekend work may be required during peak RFP and re-procurement periods. Clin
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: Oversee the development and implementation of contracting activities in network development and enhancement. Key Details: The Senior Director, Network Development & Contracting is responsible for providing strategic leadership, direction, and oversight of provi
Position Purpose: Responsible for developing and conducting a variety of training programs and auditing tools for Sunshine State Health Plan departments supporting members and providers. Key Details: The Senior Trainer role is primarily remote with 25% travel expectation through
Position Purpose: A key executive role responsible for leading and managing billing and enrollment processes across multiple regions. this position ensures operational efficiency, accuracy, and compliance with healthcare regulations, which driving strategic initiatives and foster
Position Purpose: Oversight of the Gold Card Program ensuring effective performance and communication of strategic priorities and outcomes with stakeholders. Responsibilities: - Develop and execute the strategic vision for a National Gold Card Program. - Identify opportuniti
Position Purpose: Direct and oversee all training activities, including training assessment and evaluation, material development, and training facilitation. Partner with subject matter experts to develop relevant training programs that may utilize different instructional practice
Position Purpose: Identify, negotiate and manage high performing provider and vendor partnerships. Key Details: The Contract Negotiator V delivers significant organizational value by leading complex provider negotiations, strengthening strategic partnerships, supporting affordab
Position Purpose: The Senior Infrastructure Security Engineer is responsible for operating and maturing Centene’s Attack Surface Management (ASM) and Breach Attack Simulation (BAS) programs across hybrid, cloud, on-premises, and enterprise environments. This role strengthens secu
Assist in financial analysis, pricing, and risk assessment to estimate outcomes. Support business decision-making through actuarial analysis, healthcare cost trend evaluation, and the identification of savings opportunities across healthcare data sources. Key Details: This posit
Program/Team Supported: This position supports the Population Health LTSS Care Management team, specifically the SED Waiver program. Travel: This is a field-based role requiring approximately 50% travel throughout Kansas. Travel will typically be within approximately a one-hour
Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes. - Monitor business processes and systems to assure integrity and compliance in billing and claims payment
Position Purpose: Serves as a partner and advisor between enterprise stakeholders and Enterprise Privacy & Security Risk Management (EPSRM), ensuring regulatory and contractual privacy, security, AI, and business continuity requirements are translated into practical operational c
Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educa
Position Purpose: Supports Enterprise Privacy & Security Risk Management (EPSRM) and other teams across Centene by translating complex regulatory, legislative, and contractual requirements into actionable, risk-informed analysis and advisory-ready outputs, among other duties. Se
Position Purpose: Supports Enterprise Privacy & Security Risk Management (EPSRM) and other teams across Centene by translating complex regulatory, legislative, and contractual requirements into actionable, risk-informed analysis and advisory-ready outputs, among other duties. Se
Position Purpose: Supports Enterprise Privacy & Security Risk Management (EPSRM) and other teams across Centene by translating complex regulatory, legislative, and contractual requirements into actionable, risk-informed analysis and advisory-ready outputs, among other duties. Se
Position Purpose: Supports Enterprise Privacy & Security Risk Management (EPSRM) and other teams across Centene by translating complex regulatory, legislative, and contractual requirements into actionable, risk-informed analysis and advisory-ready outputs, among other duties. Se
Position Purpose: Supports Enterprise Privacy & Security Risk Management (EPSRM) and other teams across Centene by translating complex regulatory, legislative, and contractual requirements into actionable, risk-informed analysis and advisory-ready outputs, among other duties. Se
Position Purpose: Manage and oversee the coordination of regulatory audits, examinations, and oversight activities for a regional portfolio of Medicaid health plans across the West Region. Provide leadership and direction to team members responsible for day-to-day audit execution