This is a remote position that can be located anywhere in the US.
Position Purpose:
Drive strategic healthcare transformation initiatives across health plan operations by identifying opportunities to improve clinical and operational performance, enhance member outcomes and experience, reduce healthcare costs, and support regulatory and contractual requirements.
Lead multiple concurrent initiatives from opportunity identification and business case development through implementation and performance measurement. Partner closely with clinical operations, Medical Economics, Finance, IT, Product, Provider/Network teams, Payment Integrity, and other cross-functional stakeholders to translate healthcare data and operational needs into actionable strategies and measurable results.
This role requires an understanding of the healthcare payer environment, including managed care and Medicaid, and the ability to independently lead complex initiatives that span clinical, operational, financial, and technical functions.
Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.
Key Responsibilities:
- Identify and evaluate opportunities to improve healthcare quality, clinical and operational efficiency, member outcomes, service levels, regulatory compliance, and medical cost performance.
- Lead strategic initiatives across health plan functions, including areas such as Utilization Management, Care Management, Behavioral Health, LTSS, Clinical Operations, and other payer operations.
- Partner with Medical Economics, Finance, Analytics, and business leaders to understand healthcare utilization and cost trends, identify key drivers and addressable opportunities, develop business cases, and establish appropriate performance measures.
- Interpret healthcare data and operational findings to help translate identified opportunities into actionable strategies, project plans, and measurable interventions.
- Develop strategies to realize improvement and cost-saving opportunities and facilitate organizational prioritization, leadership alignment, and resource allocation.
- Manage multiple complex projects and initiatives through the full project lifecycle, including discovery, requirements gathering, business case development, planning, implementation, measurement, and transition to operational ownership.
- Establish project objectives, milestones, deliverables, dependencies, risks, decision points, and performance measures and maintain appropriate project governance and documentation.
- Lead cross-functional workgroups involving clinical, operational, financial, analytical, technical, and executive stakeholders to drive decisions and deliver defined outcomes.
- Partner with IT, Product, and operational teams to translate business and clinical requirements into technology-enabled solutions and ensure successful implementation and adoption.
- Monitor initiative performance following implementation, partnering with business owners and Medical Economics/Analytics to evaluate outcomes, validate realized impact, and identify opportunities for continued improvement.
- Provide clear and concise communication of project status, risks, financial opportunities, decisions, and performance to senior and executive leadership through presentations, dashboards, and executive summaries.
- Navigate competing priorities and negotiate with stakeholders to secure resources, resolve issues, mitigate risks, and maintain progress toward strategic objectives.
- Maintain working knowledge of managed care operations, healthcare industry trends, regulatory requirements, and Medicaid program considerations relevant to assigned initiatives.
Education/Experience:
- Bachelor’s degree in Healthcare Administration, Business Administration, or related field, or equivalent relevant experience. Master’s degree preferred.
- 5+ years project implementation, product or program management experience.
- Experience within a healthcare payer or managed care organization strongly preferred, with knowledge of Medicaid and/or other government-sponsored health programs preferred.
- Demonstrated understanding of healthcare payer operations and the relationship between clinical operations, healthcare utilization, medical cost, quality, regulatory requirements, and financial performance preferred.
- Experience partnering with Medical Economics, healthcare analytics, Finance, or similar functions to evaluate utilization and cost trends, develop business cases, establish performance measures, and assess initiative outcomes preferred.
- Experience leading complex, cross-functional healthcare initiatives involving clinical, operational, financial, analytical, and/or technology stakeholders preferred.
- Strong executive communication, facilitation, critical thinking, and problem-solving skills, with demonstrated ability to independently drive initiatives from an identified opportunity through implementation and measurement preferred.
- Project management certification (PMP, PgMP) and/or healthcare-related credentials preferred but not required.
Pay Range: $87,700.00 - $157,800.00 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.
