Centene Corporation is a publicly traded managed care company based in St. Louis, Missouri, which is an intermediary for government-sponsored and privately insured healthcare programs. Centene ranked No. 25 on the 2023 Fortune 500.
Data Analyst I Healthcare Analytics
About the job
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose Analyze integrated and extensive datasets to extract value, which directly impacts and influences business decisions. Work collaboratively with key business stakeholders to identify areas of value, develop solutions, and deliver insights to reduce overall cost of care for members and improve their clinical outcomes.
- Interpret and analyze data from multiple sources including healthcare provider, member/patient, and third-party data
- Support execution of large-scale projects with limited direction from leadership
- Identify and perform root-cause analysis of data irregularities and present findings and proposed solutions to leadership and/or customer
- Manage multiple, variable tasks and data review processes under direct supervision within targeted timelines
- Support the design, testing, and implementation of process enhancements and identify opportunities for automation
- Support multiple functions and levels of the organization and effectively, both verbally and visually, communicate findings and insights to non-technical business partners
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience Bachelor’s degree in business, economics, statistics, mathematics, actuarial science, public health, health informatics, healthcare administration, finance or related field or equivalent experience. 0-2 years of experience in working with large databases, data verification, and data management. Working knowledge of SQL/query languages. Preferred knowledge of programmatic coding languages such as Python and R. Knowledge of statistical, analytical, or data mining techniques including basic data modeling, trend analysis, and root-cause analysis preferred. Preferred knowledge of modern business intelligence and visualization tools.
Regional and HBR Analytics Experience with emerging trend analysis, financial modeling, claims pricing, contract/network analysis, and/or ROI evaluation. Familiarity with claims payment, utilization management, provider/vendor contracts, risk adjustment for government sponsored healthcare desired.
Pay Range $54,000.00 – $97,100.00 per year
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Snowflake Enablement Engineer II
Position Purpose
This role is on the Data Platform team and will help establish a platform enablement team for our Enterprise Datahub.
Work closely with IT and business teams guiding them through onboarding, and helping them get up to speed with our analytics platforms through tailored training materials and workshops
Provide tailored support and insights…including developing and delivering enablement resources such as documentation, tutorials, and best practice guides.
Collaborate with platform and application teams to identify and resolve roadblocks, streamlining processes for a seamless customer experience
Platform Enablement
Develop and deliver enablement programs that drive adoption and effective utilization of the Enterprise Datahub
Create high-quality enablement resources (e.g., tutorials, how-to guides, FAQs) tailored to the needs of different data consumers within the organization
Proactively identify and address knowledge gaps among data consumers and provide ongoing support to ensure successful data onboarding and integration
Gather and analyze feedback from data consumers to continuously improve the Enterprise Datahub platform and its supporting enablement programs
Performs other duties as assigned
Complies with all policies and standards
Education/Experience
A Bachelor’s degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science).
Requires 2 – 4 years of related experience.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
Technical Skills
- Understanding of cloud computing concepts and technologies, preferably with experience in AWS
- Experience in at least one scripting or programming language (e.g., Python, SQL) for automating tasks and data analysis
- Experience with infrastructure-as-code tools (e.g., CloudFormation, Terraform, GitLab) for managing and deploying cloud resources
- Experience with data warehousing and data lake concepts, and experience with new age data analytics platforms (Snowflake)
Soft Skills
- Intermediate – Seeks to acquire knowledge in area of specialty
- Intermediate – Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
- Intermediate – Ability to work independently
Pay Range $72,400.00 – $130,100.00 per year
Authorization Specialist II
About the job
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
- Qualified candidates must reside in the state of Florida and be able to work 11AM-8PM EST Monday-Saturday, with 1 week day off. The schedule will include working every Saturday**
Position Purpose Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
- Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
- Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
- Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment
- Performs data entry to maintain and update various authorization requests into utilization management system
- Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer
- Remains up-to-date on healthcare, authorization processes, policies and procedures
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience Requires a High School diploma or GED.
Requires 1 – 2 years of related experience.
Knowledge of medical terminology and insurance preferred.
Pay Range $17.17 – $26.97 per hour
Pharmacy Coordinator
Position Purpose Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan’s pharmacy program.
- Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process
- Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
- Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns
- Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
- Assist Provider Relations and various departments with educating providers on the health plan’s pharmacy process
- Assist with the pharmacy utilization review and reporting process
- Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
- Assist with members’ inquiries related to the formulary process
- Performs other duties as assigned
- Complies with all policies and standards
For Centene Pharmacy Services
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users.
License/Certificate Current state’s Pharmacy Technician license preferred.
Pay Range $18.66 – $31.73 per hour
Diversity, Equity, & Inclusion Intern (Undergraduate – Summer)
Position Purpose Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business.
- Learn various job functions within the Managed Care industry and explore various career opportunities
- Apply academic knowledge and learn new skills by contributing to various projects
- Research various legal, regulatory, and other topics within functional area and industry
- Attend training and development presentations to enhance professional competencies
Duties
- Cross functional collaboration with different departments including HR, Communications, Business and Development, etc.
- Work in a Fortune 22 Diversity Equity Inclusion office through real world experiences and projects.
- Write and create communications for DEI related articles, social media posts, and event flyers.
- Perform and report on data analytics to compare industry and company benchmarks for DEI
Skills
- Strong writer, willing to create written content for multiple purposes.
- Strong communicator, ability to present in meetings and talk further on the work accomplished.
- Strong data analytics, ability to research, record, and speak on analytics relevant to all things DEI
The salary range is $16.00 – $24.00 per hour