Jobs at Centene Corporation

Leads large-scale healthcare technology migrations and enterprise programs, overseeing scope, schedules, budgets, risks, dependencies, cross-functional teams, executive communications, dashboards, training, and issue escalation. Coordinates project managers and business analysts while supporting clinical platform integration, interoperability, cutover, go-live, stabilization, and organizational transformation initiatives.

Coordinates statewide clinical appeals, fair hearings, and external reviews. Evaluates clinical information using recognized medical-necessity criteria, prepares case reviews and compliant response letters, maintains appeal files and logs, and collaborates with medical directors to clarify determinations. The role also coordinates fair hearings, follows up with members and providers, and maintains knowledge of NCQA and Oregon regulatory requirements.

Conduct on-site quality reviews and medical record audits of delegated entities and provider offices, investigate complaints and sentinel events, develop corrective action plans, compile utilization and quality reports, coordinate QIC activities, and support community clinical initiatives and provider engagement.