Jobs at Centene Corporation

Oversee operational strategy, cross-functional initiatives, and teams of business and technical analysts supporting regulated communications. Develop performance-tracking methodologies, analyze data and ROI, improve processes, reduce waste and costs, and enhance stakeholder satisfaction. Advise on continuous improvement, support strategic initiative execution, and present program insights. Requires business process or data analysis experience, with up to 25% travel.

Develops and manages formularies, prior authorization criteria, pharmacy policies, drug utilization review programs, and quality initiatives for Indiana Medicaid and Medicare operations. Analyzes pharmacy and performance data, supports clinical teams and case management, coordinates medication therapy management, and partners with providers, vendors, and internal departments. The role requires audit-ready work, strong clinical judgment, regulatory compliance, and collaboration to improve medication access, safety, and quality outcomes.

Develops and maintains medication formularies, clinical criteria, pharmacy policies, and quality initiatives for managed care plans. Reviews prior authorization requests, evaluates clinical literature and treatment guidelines, supports utilization and drug utilization review programs, coordinates Medicare medication therapy management, and provides clinical guidance to internal teams and members. The role also contacts providers, monitors quality measures, supports performance improvement, and ensures pharmacy practices align with state requirements.

Manages relationships with contracted healthcare providers on behalf of a health plan. Serves as the primary provider contact, resolves claims and operational issues, delivers education and orientations, and improves network performance. Evaluates quality, risk, cost, utilization, and HEDIS measures while developing performance improvement strategies. Requires local travel four days per week and coordination with internal partners on provider-related issues.