Jobs at Centene Corporation

Lead and conduct enterprise-wide compliance and ethics investigations across business units and health plans. Assess allegations, review documents, interview witnesses, prepare investigation reports, recommend remediation or discipline, track corrective actions, maintain case files in centralized systems, produce metrics and presentations, and collaborate with cross-functional stakeholders to ensure regulatory defensibility.

Manage and develop standard and custom formularies across Commercial, Medicaid, Medicare Part D and marketplace lines. Review drug literature and utilization trends, create formulary recommendations, prior authorization criteria, clinical edits, and reports. Support P&T committee processes, provide clinical guidance to pharmacy technicians, and ensure regulatory and fraud/abuse reporting compliance.

Lead pharmacy operations across multiple markets and products, develop and implement pharmacy benefit management programs, manage vendor contracts and accreditation participation, analyze utilization and financial data, oversee pharmacy staff, and support provider education and budget planning to achieve organizational pharmacy and medical goals.

Supervise utilization management nursing team handling prior authorization, concurrent and retrospective reviews. Ensure compliance with regulations and quality standards, coach and evaluate staff, lead process improvements, assist hiring and training, and collaborate with senior management on UM policies and complex member care issues.

Lead enterprise social listening and monitoring, detect and assess reputational risk, produce intelligence reports and dashboards, manage social listening platforms and vendor relationships, establish monitoring frameworks and governance, train users, and support platform operations, access controls, and audit-ready processes.

The Senior Business Systems Analyst collaborates with stakeholders to translate complex requirements into technical specifications, ensuring alignment with strategic goals. Responsibilities include gathering business requirements, creating process models, managing project lifecycles, and providing user support.

Act as a liaison to improve pharmacy quality performance, collaborating with providers and pharmacies, and ensuring timely insights while managing territory engagement plans.

Oversee the Gold Card Program, enhancing development initiatives and integrating adaptive technology to achieve optimal behavior change outcomes while ensuring financial performance and value propositions.