Principal Incident Response Analyst CentenePrincipal Incident Response AnalystHull, IL$121,500–$224,900 / yearSee Centene Terms & Conditions at https://www.centene.com/terms-conditions.html and Privacy Policy at https://www.centene.com/privacy-policy.html and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. Education/Experience: A Bachelor's degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science) and requires deep functional and Centene specific knowledge with 6 – 8 years of related experience.
NewPsychologist Reviewer CentenePsychologist ReviewerWILMINGTON, NCRemote$87,700–$157,800 / yearAuthorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care. For ABA Reviewers only, working knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence-based practices designed for individuals with Autism Spectrum Disorder.
NewPsychologist Reviewer CentenePsychologist ReviewerWINSTON SALEM, NCRemote$87,700–$157,800 / yearAuthorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care. For ABA Reviewers only, working knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence-based practices designed for individuals with Autism Spectrum Disorder.
Remote Behavioral Medical Director, Eastern Region CenteneRemote Behavioral Medical Director, Eastern RegionCharleston, SCRemote$236,500–$449,300 / yearCollaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Supervisor, Utilization Management (RN) CenteneSupervisor, Utilization Management (RN)Florissant, MO$75,300–$135,400 / yearEducates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers. Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services.
Remote Medical Director, Appeals CenteneRemote Medical Director, AppealsTrout Lake, WARemote$236,500–$449,300 / yearCollaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Remote Behavioral Medical Director, Central Region CenteneRemote Behavioral Medical Director, Central RegionAfton, TXRemote$236,500–$449,300 / yearCollaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Senior Business Solutions Architect CenteneSenior Business Solutions ArchitectTallahassee, FL$107,700–$199,300 / yearCreate and maintain core business architecture models, such as value streams, business capabilities, information maps, and strategy trees. Ensures deliverables are met, by assisting with design, execution, and value estimation and realization for initiatives.
Principal Incident Response Analyst CentenePrincipal Incident Response AnalystArgenta, IL$121,500–$224,900 / yearEducation/Experience: A Bachelor's degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science) and requires deep functional and Centene specific knowledge with 6 – 8 years of related experience. Ties third party attack monitoring services and threat reporting services, into internal CIRT (Cyber Incident Response Team) communications systems.
Remote Behavioral Medical Director, Eastern Region CenteneRemote Behavioral Medical Director, Eastern RegionAnderson, SCRemote$236,500–$449,300 / yearCollaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Senior Business Solutions Architect CenteneSenior Business Solutions ArchitectHialeah, FL$107,700–$199,300 / yearCreate and maintain core business architecture models, such as value streams, business capabilities, information maps, and strategy trees. Ensures deliverables are met, by assisting with design, execution, and value estimation and realization for initiatives.
Supervisor, Payment Integrity- Coding & Clinical (DRG) CenteneSupervisor, Payment Integrity- Coding & Clinical (DRG)Jefferson City, MO$87,700–$157,800 / yearSupervise and coordinate the day-to-day activities of the Coding & Clinical Review team within Payment Integrity, ensuring accurate diagnosis-related group assignment, clinical validation, and audit outcomes in alignment with established policies, regulatory requirements, and organizational objectives. The position may oversee diagnosis-related group audit, Quality Assurance, Readmissions, Appeals, or broader operational teams and serves as a subject matter expert for complex coding, clinical validation, and audit-related matters.
Supervisor, Payment Integrity- Coding & Clinical (DRG) CenteneSupervisor, Payment Integrity- Coding & Clinical (DRG)Columbia, MO$87,700–$157,800 / yearSupervise and coordinate the day-to-day activities of the Coding & Clinical Review team within Payment Integrity, ensuring accurate diagnosis-related group assignment, clinical validation, and audit outcomes in alignment with established policies, regulatory requirements, and organizational objectives. The position may oversee diagnosis-related group audit, Quality Assurance, Readmissions, Appeals, or broader operational teams and serves as a subject matter expert for complex coding, clinical validation, and audit-related matters.
Remote Behavioral Medical Director, Central Region CenteneRemote Behavioral Medical Director, Central RegionCarlton, TXRemote$236,500–$449,300 / yearCollaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Remote Behavioral Medical Director, Central Region CenteneRemote Behavioral Medical Director, Central RegionLadonia, TXRemote$236,500–$449,300 / yearCollaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Remote Behavioral Medical Director, Eastern Region CenteneRemote Behavioral Medical Director, Eastern RegionGreenville, SCRemote$236,500–$449,300 / yearCollaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Remote Behavioral Medical Director, Eastern Region CenteneRemote Behavioral Medical Director, Eastern RegionSimpsonville, SCRemote$236,500–$449,300 / yearCollaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Remote Medical Director, Appeals CenteneRemote Medical Director, AppealsWhite Salmon, WARemote$236,500–$449,300 / yearCollaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Senior Business Solutions Architect CenteneSenior Business Solutions ArchitectWest Palm Beach, FL$107,700–$199,300 / yearCreate and maintain core business architecture models, such as value streams, business capabilities, information maps, and strategy trees. Ensures deliverables are met, by assisting with design, execution, and value estimation and realization for initiatives.
Supervisor, Payment Integrity- Coding & Clinical (DRG) CenteneSupervisor, Payment Integrity- Coding & Clinical (DRG)Saint Louis, MO$87,700–$157,800 / yearSupervise and coordinate the day-to-day activities of the Coding & Clinical Review team within Payment Integrity, ensuring accurate diagnosis-related group assignment, clinical validation, and audit outcomes in alignment with established policies, regulatory requirements, and organizational objectives. The position may oversee diagnosis-related group audit, Quality Assurance, Readmissions, Appeals, or broader operational teams and serves as a subject matter expert for complex coding, clinical validation, and audit-related matters.