Teams at Centene Corporation

Reviews Applied Behavioral Analysis services for medical appropriateness, conducts behavioral health prior authorizations, analyzes member data, collaborates with providers, educates members and families, and recommends care process improvements. Requires an independent clinical license or BCBA certification, behavioral health and ABA expertise, and experience assessing ABA treatment plans and utilization.

Manages provider network adequacy monitoring, analysis, reporting, and gap remediation for Medicaid and Medicare lines of business. Leads Network Adequacy Committee meetings, prepares regulatory and leadership reports, supports exception requests, and evaluates network impacts from contracting and strategy initiatives. Develops dashboards, trackers, workflows, and business documentation while coordinating cross-functional teams and tracking action items. Serves as a subject matter expert on provider network composition, access, adequacy, and reporting.

Leads complex, cross-functional transformation programs supporting Provider Data Operations. Manages initiatives from discovery through implementation and operational transition, including requirements, planning, budgets, risks, dependencies, governance, stakeholder alignment, process improvement, automation, and change management. Tracks performance and value realization while presenting status and recommendations to senior leadership. The role drives improvements in operational efficiency, provider data accuracy, regulatory compliance, and enterprise consistency.