Centene Corporation Group

Plan Chief Financial Officer Austin-5900 E Ben White Blvd (10703) Remote-TX Location: Austin United States Job Description: Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members. Position Purpose: Provide leadership and oversight of all aspects of finance for the Business Unit - Oversee all finance related activities for business unit including developing and monitoring progress against Annual Operating Plan. - Responsible for financial analysis, identification of month end financial drivers, and forecasting including headcount planning to ensure compliance with state requirements. - Responsible for identifying medical cost trends and leadership of medical cost improvement initiatives. - Perform financial impact analysis for new contracts and support negotiations. - Review monthly performance and financial results of the business unit and provide recommendations to senior management. - Responsible for the business unit's contribution to corporate. - Perform duties as Chief liaison between Corporate Finance and the Business Unit. - Establish financial strategic vision, objectives, policies and procedures in support of the overall strategic plan. - Oversee and validate pricing models and lead initiatives to identify inefficiencies and areas of development and improvement. - Direct health plan analytical needs and coordinate reporting strategy. - Act as a lead for internal and external audits. - Lead rate setting activity and coordinate corporate and state actuaries. - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: Bachelor's Degree in Finance, Accounting, Economics, Business Administration required. Master's Degree preferred. 10+ years in a high level finance role in the healthcare or insurance industry required. CPA preferred. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Pay Range: $227,700.00 - $431,400.00 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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

• Conduct analysis, pricing and risk assessment to estimate financial outcomes • Manage health plan specific actuarial needs • Produce actuarial reports to aid in developing corporate strategy • Serve as the main point of contact for actuarial related forecasting activities • Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes • Develop probability tables based on analysis of statistical data • Research and analyze the impact from legislative changes • Assess cash reserves and liabilities enable payment of future benefits • Analyze various data reports, identify trends and gaps and recommend action • Determine the equitable basis for distributing money for insurance benefits • Create and update actuarial reports

• Designs and develops scalable solutions using AI tools and machine-learning models. • Performs research and testing to develop machine learning algorithms and predictive models. • Utilizes big data computation and storage tools to create prototypes and datasets. • Conducts model training and evaluation. • Integrates, tests, tunes, and monitors solutions. • Participates in model brainstorming conversations with new potential internal customers interested in AI/ML capabilities. • Works alongside internal customers that are requesting AI/ML capabilities to understand overall business objective & impact. • Analyzes use cases of ML algorithms and apply findings to enable business decisions. • Writing moderately complex SQL and Python/R code to extract data from various databases and data sources. • Explores and visualizes data to gain an understanding and verify data quality. • Conduct exploratory data analysis from complex data sources and build key data sets to support operational analysis. • Builds ML/AI models using common methods within R and Python. • Analyzes ML algorithms that could solve a problem and ranks them by success probability. • Analyzes errors of the model and designs strategies to overcome them. • Develop logging, alerting, and mitigation strategies for handling model errors. • Develop AI/ML models to distinguish relevant content or events and recognize patterns. • Designs and develops AI/ML models to predict member outcomes. • Evaluate and design experiments to monitor key model metrics and identify improvement opportunities. • Participate in presentations and communicate research analysis results to non-technical business partners. • Produces fairness review for each model to ensure it's free of bias. • Set up CI/CD pipelines used for model automation. • Model deployment with containers such as Kubernetes and Docker. • Produces clean & readable code that has been properly unit tested and optimized.

• Provide strategic oversight and leadership directly to pharmacists-in-charge (PICs) across multiple locations • Responsible for all pharmacy operational matters at these facilities including performance management metrics • Manage PICs directly for multiple facilities across the organization, including ensuring employees’ performance is in compliance with regulatory requirements • Establish the strategic vision, objectives, policies and procedures for the pharmacy program in support of the corporate strategic vision • Manage and analyze operating costs and participate in preparing the annual budget for the assigned work function at both corporate and the health plans • Formulate and ensure adherence with policies, operating procedures and goals in compliance with internal and external governing bodies • Collaborate with internal departments to facilitate resolution and root cause analysis for cross-functional operational issues, including pharmacy audit, pharmacy communications and network pricing • Oversee the development and management of pharmacy communication, support and coordinate orientation, education and training activities for providers in the pharmacy network

• Perform internal audits including execution of strategic, operational, financial, and compliance risk-based audits • Leverage artificial intelligence, automation, and data-enabled tools to enhance audit efficiency • Partner with Internal Audit team members to design, develop, and implement data analytics and AI-enabled solutions • Develop and maintain reusable, automated, and AI-assisted audit procedures • Execute risk-based audits assessing controls and processes for scalability, effectiveness, efficiency, and risk mitigation strategies • Assist in audit planning incorporating data analytics, automation, and AI-enabled procedures into audit work • Draft audit reports summarizing findings and recommendations, including consolidation of metrics and data visualization • Develop and communicate audit observations, recommendations, process improvement opportunities, and best practices • Assist audit team in performing special projects and implementing internal audit best practices • Comply with all policies and standards

• Manage populations of patients who meet high risk criteria in order to improve disease state outcomes and improve medication related safety • Ensure safe, effective, and cost-effective medication therapy will be implemented for all patients in their care and monitor care appropriately • Support quality department to improve HEDIS metrics on projects related to medication adherence and routine health visits • Provide clinical recommendations pertaining to, but not limited to gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution and generic substitution • Utilize client formulary information and member specific benefits to guide appropriate medication recommendations • Be aware of current and emerging clinical trends and educate clinical team, physicians and other prescribers • Participate in the development of educational materials that may be presented as education intervention programs • Collaborate with physicians and other prescribers by reviewing patients drug profiles to help safeguard against new prescriptions having unintended side effects and by working with prescribers to assure that the drugs prescribed are eligible for coverage; are low cost, high quality products • Outreach to physicians to clarify medication regimens and make recommendations • Conduct research and analysis to identify cost management and process/quality improvement opportunities

• Define and develop standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D and the Health Information Marketplace • Develop drug product review and formulary recommendations by assessing drug use trends, new drug releases and review of primary literature • Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines • Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting • Develop clinical criteria for review of non-formulary or non-preferred drug lists medications and communicate recommendations to clients • Develop and design clinical edits to adjudicate claims and enhance drug utilization • Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design • Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews • Provide clinical guidance and support to the assigned pharmacy technicians • Provide support documentation and develop communication for the Pharmacy & Therapeutic (P&T) Committee review process and decisions • Performs other duties as assigned

• Manage all aspects of pharmacy operations in two markets with multiple products • Perform duties to develop, direct and implement a pharmacy benefit management program • Aid in formulating and administering related organizational policies and procedures, including pharmacy service quality, pharmacy utilization management and achievement of Company goals for pharmacy and medical programs • Establish the strategic vision, objectives and policies and procedures for the pharmacy program in support of the Corporate strategic vision for multiple plans and markets • Plan, direct and implement pharmacy activities for multiple plans and products • Act as the pharmacy contract administrator for the development and implementation of key contracts and ensure that relevant performance standards are met by vendors • Participate in external accreditation initiatives for multiple plans and products • Manage and analyze operating costs and participate in preparing materials needed for budget planning or special initiatives • Generate, review and analyze drug utilization, utilization management, financial and other ad-hoc reports, records and directives • Confer with staff to obtain data required for planning work function activities • Review statistical analysis in support of recommendations and/or decision making for policies and operational procedures • Maintain daily communication with plan management relative to each market and product • Manage pharmacy department staff to assure adequate coverage and support in multiple locations and for multiple products • Support provider education initiatives such as counter detailing and incentive programs in multiple markets

Title: Special Investigation Unit, Investigator Location: Remote, TX Full time job requisition id 1642045 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. Please note: this is a remote role with preference on candidates located in Texas. Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. - Conduct investigations of potential waste, abuse, and fraud - Document activity on each case and refer issues to the appropriate party - Perform data mining and analysis to detect aberrancies and outliers in claims - Develop new queries and reports to detect potential waste, abuse, and fraud - Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions - Assist with complex allegations of healthcare fraud - Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies - Complete various special projects and audits - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: Bachelor's Degree Business, Criminal Justice, Healthcare, or related field, or equivalent experience required. 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required. Pay Range: $56,200.00 - $101,000.00 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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 Ac

Title: SIU Investigator Location: Remote-NY Full time job requisition id 1642047 Job Description: 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. Please note: this is a remote role with high preference on candidates residing within New York. Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. - Conduct investigations of potential waste, abuse, and fraud - Document activity on each case and refer issues to the appropriate party - Perform data mining and analysis to detect aberrancies and outliers in claims - Develop new queries and reports to detect potential waste, abuse, and fraud - Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions - Assist with complex allegations of healthcare fraud - Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies - Complete various special projects and audits - Performs other duties as assigned. - Complies with all policies and standards Education/Experience: Bachelor's Degree Business, Criminal Justice, Healthcare, or related field, or equivalent experience required. 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required. Minimum of five (5) years in healthcare field working in fraud, waste and abuse investigations and audits, (or) five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) seven years of professional investigation experience involving economic or insurance related matters. Pay Range: $56,200.00 - $101,000.00 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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