Teams 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.