Jobs at Centene Corporation

Manages clinical, quality improvement, coding, documentation, and data submission projects for a health plan. Coordinates committees and cross-functional workgroups, develops work plans and interventions, analyzes clinical data and workflows, prepares reports, tracks action items, and supports provider partnerships and Triple Aim objectives. The role requires collaboration with medical leadership and experience in managed care, hospital, or medical group settings, with emphasis on quality improvement, utilization management, or clinical operations.

Support clinical policy by reviewing and coding Clinical Coverage Guidelines and Claims Edit Guidelines, maintaining authorization management tools, conducting regulatory and coding research, liaising with vendors and cross-functional teams, and serving as a coding and claims payment subject-matter expert for medical management and implementation projects.

Provide clinical and operational support for utilization and case management by developing, implementing, and monitoring clinical guidelines, policies, SOPs, and regulatory notices. Measure workflow effectiveness, run basic reports, research best practices, create documentation and training materials, and collaborate with leadership, medical directors, and stakeholders to ensure compliance, quality improvement, and efficient implementation of clinical processes.